PEDIATRIC DENTISTRY
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CROWNS IN
PEDIATRIC DENTISTRY
Editor
Prashant Babaji
MDS
Professor
Department of Pedodontics and Preventive Dentistry
Sharavathi Dental College and Hospital
Shivamogga, Karnataka, India
Foreword
VV Subba Reddy
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ISBN: 978-93-5152-439-7
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Dedicated to
Almighty for giving me immense pleasure to write this book
My little master Tanush for his continuous love, understanding and
support during preparation of the book.
My parents and family members for their constant encouragement to go forward.
My teachers who shared their knowledge with me.
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Contributors
Anju Bansal
Senthilnathan S
Reader
Department of Pedodontics
Buddha Dental College
Patna, Bihar, India
Jalarak C Patel
Shashikiran ND
Senior Lecturer
Department of Pedodontics
Goenka Research Institute of Dental Science
Gandhinagar, Gujarat, India
Nitin Sharma
Suresh BS
Reader
Department of Pedodontics
Rajasthan Dental College
Jaipur, Rajasthan, India
Professor
Department of Pedodontics
Sharavathi Dental College and Hospital
Shivamogga, Karnataka, India
Poonacha KS
Vikram Shetty K
Reader
Department of Pedodontics
KM Shah Dental College and Hospital
Vadodara, Gujarat, India
Prashant Babaji
Professor
Department of Pedodontics and Preventive Dentistry
Sharavathi Dental College and Hospital
Shivamogga, Karnataka, India
Raghavendra Shetty
Professor
Department of Pedodontics
Chhattisgarh Dental College and Research Institute
Rajnandgaon, Chhattisgarh, India
Vinaykumar S Masamatti
Senior Lecturer
Department of Conservative Dentistry and
Endodontics
Maratha Mandel Dental College
Belagavi, Karnataka, India
Department of Prosthodontics
Mumbai, Maharashtra, India
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DIRECTOR
Foreword
It is an honor for me to write the foreword to my own students special book on, Crowns in Pediatric
Dentistry. This informative book provides information on conventional and newer crowns as
well as advanced techniques. It covers illustrations, principles and colorful images for better
understanding. The book helps the readers to improve their current concepts and to upgrade
their knowledge and techniques for crown placement and to solve the clinical problems.
I am confident that the book written by Dr Prashant Babaji will be very useful for clinicians,
undergraduate and postgraduate dental students for successful dental practice.
VV Subba Reddy
BDS MDS FICD (USA)
Department of Pedodontics
Director and for Principal, College of Dental Sciences
Bapuji Educational Association
Davangere, Karnataka, India
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Preface
Nowadays various pediatric crowns are available, but available information and long-term clinical
studies about it are very scarce. Pediatric crown development has moved from conventional
unesthetic stainless steel crown to strip crown, ceramic and preveneered crown with better
clinical success and patient and parent satisfaction. Hence, the present book aims to provide
information about conventional and newer pediatric anterior and posterior crowns.
Prashant Babaji
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Contents
1. Introduction and Historical Developments
Prashant Babaji
Historical developments in Pediatric crowns2
2. General Considerations
21
Prashant Babaji, Jalarak C Patel, Poonacha KS, Anju Bansal, Raghavendra Shetty
Classifications of Crowns21
Restoration of Severely Decayed Tooth with Post and Core21
Full Coronal Restorations in Children22
All Metal Crowns23
Jalarak C Patel, Poonacha KS, Raghavendra Shetty
Composition of Crowns23
Stainless Steel Crowns23
Ion Crowns/Nickel-Chromium Crowns25
Clinical Procedures for SSC34
Reduction of Tooth39
Crown Adaptation43
Response of Gingival Tissues to Stainless Steel Crown Restoration51
Anterior Stainless Steel Crowns67
Aluminum Crowns70
SSC With Facing/Open Faced Stainless Steel Crown/Chairside Veneered SSC72
Veneering Technique for Anterior Stainless Steel Crown73
Composite Veneering of Primary Molar SSC74
Resin Crowns/Composite Crowns75
Composite Strip Crown for Anterior and Posterior Teeth75
Composite Shell Crowns83
New Millennium Crown84
Glass Ionomer Crown84
Polycarbonate Crown85
Kudos Crowns88
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xiv
PedoNatural Crown90
Anju Bansal
Pedo Jacket Crown93
Artglass Crowns/Glastech Crowns94
Preveneered Stainless Steel Crowns97
NuSmile Crowns100
Flex White Faced Pediatric Crown103
Pedo Pearls (Aluminum Crowns with Facing)104
Cheng Crown107
Whiter Biter Crown109
Pedo Compu Crown109
High Density Polyethylene Veneered Crowns For Children110
Dura Crowns110
All Ceramic/Porcelain/Zirconia Jacket Crown111
ZIRKIZ Crowns111
EZ-crown113
Kinder Krowns115
Cerec Crowns-All Ceramic CrownsCAD/CAM System119
Ceramo Base Metal Crown121
Biologic Crown122
Limitations122
Tooth Preparation122
Fabrication of Crown Portion122
Radiographic Evaluation123
Cementation of Biologic Crown123
125
5. Management of Complications
133
141
Prashant Babaji
Crown Order Forms146
Index 153
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C hapter
1
Introduction and
Historical Developments
Prashant Babaji
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HISTORICAL DEVELOPMENTS
IN PEDIATRIC CROWNS
1947Preformed crowns (PMC) were
introduced by Rocky Mountain company
1950Stainless steel crown (SSC) was
described by Engel and popularized by
Willium Humphrey to Pediatric dentistry
1950 to 1968Various modifications in
preformed crowns occurred
1964Biologic restoration were advocated
by Chosak and Eildeman
1970Polycarbonate
crowns
were
introduced
1971Mink and Hill advised SSC
modification for over and undersized
crowns. SSC medications for deep
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C hapter
2
General Considerations
Prashant Babaji, Shashikiran ND
IMPORTANCE OF RESTORING
PRIMARY TEETH
Although advances in the application of
preventive dentistry techniques, widespread
acceptance of community fluoridated water
and increased dental education in parents have
reduced the incidence of caries in children,
there is still a high prevalence of early childhood
caries especially in the lower socioeconomic
population. Clinically early childhood caries
proceeds from early involvement of maxillary
incisors to other teeth leading to rapid spread
and destruction of other teeth if neglected.
Esthetic treatment of severely decayed
anterior primary teeth is one of the greatest
challenges to pediatric dentists. In the last
half of century the emphasis on treatment of
extensively decayed primary teeth shifted from
extraction to restoration. Early restorations
consisted of placement of stainless steel bands
or crowns on severely decayed teeth. While
functional, they were unesthetic and their
use was limited to posterior teeth. Over the
last two decades there has been an explosive
interest by adults in esthetic restoration of their
compromised dentition. Similarly, a higher
esthetic standard is expected by parents for
restoration of their childrens carious teeth.
Esthetic full coverage restorations are available
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General Considerations
FLOW CHART 2.1 Importance of primary teeth
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Occlusion
Before tooth preparation and crown adaptation
check for occlusion. Occlusion is the contact
of the mandibular teeth against the opposing
maxillary teeth during functional and non
functional movement of the mandible. The
static position of the bite is called centric
occlusion. Check for incisor, canine and molar
relationships.
Sensitivity
Following vital tooth preparation, dentine will
be exposed resulting into sensitivity of tooth
hence prepared tooth should be covered with
varnish before crown cementation.
Gingival Health
There are chances of gingival laceration during
tooth preperation which will heal in due time.
Gingival inflammation and recession occurs
if crown is not properly adapted or irritating
cement left after cementing crown. Food
impaction occurs if contact areas left open.
Hence care should be taken to remove excess
cement, crimp the crown for close adaptation,
and maintain proximal contact by proximal
contouring the crown or by adding solder.
Finish Lines
The finish line is a continuous edge that borders
the entire preparation commonly the location
where the bur stops. It is essential that you have
a mental image of the location and contour of
a preparations finish line in order to contour a
temporary restoration for that tooth.
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General Considerations
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Indications
(According to the clinical guidelines for the
American Academy of Pediatric Dentistry)
Children at high risk with anterior and/or
posterior decay
Children with extensive decay
Large lesions or multiple surface lesions
Pulpally treated teeth
Involved inscisal edge
Extensive cervical caries
Minimal caries but poor oral hygiene
Difficult to control moisture due to child
behavior management problems.
Other Indications
Hypoplastic defects
Significant tooth loss/fracture due to trauma
Phychologic benefit
Posterior crown for masticatory function
and to maintain arch length
Unesthetic incisors due to discoloration/
intrinsic stain.
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Contraindications
Non restorable teeth
Teeth which can be restored by conventional
means.
Advantages
Maintains esthetics of child
Avoids development of psychological and
functional problems due to loss of primary
teeth
Preserves arch length and space.
Crown Selection
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General Considerations
1.
Contouring pliers (Fig. 2.8): Gordon
pliers (No. 137) used for general
contouring and shaping
Johnsons Ball and socket contouring
pliers (No. 800112): Used to improve
contour at interproximal contacts and
gingival margins for stainless steel and
temporary crowns.
2.
Crimping pliers No. 800417, No.
800421: Specially designed to crimp the
FIGURE 2.6B Handpiece (arotor, straight), different tooth preparation burs (round, round end taper, thin taper,
flame-shaped), Crown finishing and polishing burs
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10
ISOLATION PROCEDURE:
RUBBER DAM APPLICATION
Rubber dam isolation method in pediatric
restorative dentistry is strongly recommended
during tooth preparation and crown placement
for better access and visualization.
FIGURE 2.8 Crown adaptation pliers
FIGURES 2.9A TO G Crown cutting scissors (Festooning, curved, starignt and all purpose scissors: (A) Festooning
scissor; (B) Straight crown cut scissor; (C) Curved scissor; (D) All purpose scissor; (E) Crown cutting scissor;
(F and G) Crown cutting scissors: (i) Curved festooning; (ii) Straight smooth; (iii) Curved
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General Considerations
Contraindications
Indications
For isolation
Prevents aspiration of dental equipments
and materials
Prevention of cross infection
For clear visualization of operatory area.
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FIGURES 2.10A TO I (A) Rubber dam sheet; (B) Rubber dam frame; (C) Template; (D) Punch; (E) Forcep;
(F) Clamps; (G) Rubber dam napkin, dental floss, lubricants; (H) Fast dam, quick dam; (I) Different rubber dam
frames (metal and plastic), forcep, punch
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General Considerations
13
FIGURES 2.11A AND B (A) Rubber dam punch; (B) Method of punching the sheet
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14
B
FIGURES 2.13A AND B Wingless (A) and winged (B) clamps
FIGURES 2.14A AND B Individual tooth isolation with rubber dam and securing with floss and clamp
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General Considerations
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15
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16
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CEMENTATION/CEMENTS USED
FOR CEMENTATION OF CROWNS
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General Considerations
Zinc phosphate
GIC
Resin modified glass ionomer
Zinc polycorboxylate cement
Zinc oxide eugenol cement
Resin cementPanavia 21
The prevailing opinion on the retention
of steel crowns appears to be that the cervical
adaptation of the crown to the tooth is the
most important aspect. Noffsinger et al. tested
retentive properties of three dental cements
using stainless steel crowns fitted to extracted
third molar teeth. No significant difference was
found between the overall mean retentive forces
of the polycarboxylate cement and the two
17
FIGURE 2.16 Different cements for crown cementation (left to right, GIC, polycarboxylate, zinc phosphate,
zinc oxide eugenol, silicophosphate cement resin-Panavia 21 cements)
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General Considerations
Silicophosphate Cement
Due to fluoride release, silicophosphate reduces
caries activity. The powder is essentially zinc
oxide and the liquid largely polyacrylic acid.
Silicophosphate shows the highest 7-days
compressive strength (about 25,000 psi),
whereas copper and zinc phosphate cements
have compressive strength about 22,000 psi.
Polycarboxylate Cement
It is developed to provide a chemical bond
between tooth structure and cement. By virtue
of its chemical structure the polyacrylic acid
chemically binds or chelates with certain
cations. Thus tooth calcium or phosphorous
chemically unites with the setting cement. It
consists of a mixture of zinc oxide powder with
a polyacrylic acid liquid. It was observed as
a direct bonding between the stainless steel,
carboxylate cement, and enamel (Mizrahi and
Smith, 1968). Polycarboxylate cements have
minimal irritation effect on the pulp, same as
zinc oxide-eugenol. Polycarboxylate cements,
when compared with zinc phosphate and
improved zinc oxide eugenol cement, have a
high level strength (Arfali and Asgar, 1978).
However, the strength is not related to increased
physical properties such as tensile strength,
compressive strength, or film thickness.
The main advantage of polycarboxylate
cement is the low irritant factor to oral tissue.
There is adhesion to tooth substance and
stainless steel alloys. Other physical properties
are similar to the phosphate cement. The
disadvantages are the requirements for precise
proportioning, optimum manipulation, and the
need for a clean, uncontaminated tooth surface.
Zinc (from zinc oxide) causes entrancement
binding whereas certain restorative metals bind
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20
Resin CementPANAVIA 21
(Fig. 2.16)
Panavia 21 in a self etching advance resin
cement that bonds directly to metal and silinated
surface with no need for a bonding agent. The
setting mechanism of Panavia 21 provides
custom working time and trouble free clean
up. It is available in three different radiopaque
shades and translucencies. It is indicated for
the cementation of metal crowns, bridges and
inlays/onlays. It is antibacterial, eliminates the
need to use additional disinfectants.
Two other categories of cements are acrylic
and composite resins. Problems encountered
have been proportioning and manipulation
difficulties, to create a film thickness, difficulty in
removing excess, and (especially) postoperative
sensitivity. Their strength is adequate to excellent and their solubility is low, but these advantages are far outweighed by their disadvantages.
02.indd 20
BIBLIOGRAPHY
1. Anterior crowns used in children. Morenike
Ukpong. Dep of Paediatric Dentistry, Obafemi
Awolowo University, Ile-Ife, Nigeria.
2. Schwartz s. Full coronal aesthetic restoration of
anterior primary teeth. Crest, Oral-accessible at
www.dentalcare.com, 2012, 21 pages.
3. Guideline on Pediatric Restorative Dentistry.
Reference Manual. Pediat Dent. 2013; 34(6):
21421.
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C HAPTER
3
Different Crowns Used in
Pediatric Dentistry
Prashant Babaji, Jalarak C Patel, Poonacha KS, Anju Bansal, Raghavendra Shetty
CLASSIFICATIONS OF CROWNS
Luted
Stainless steel crown
SSC with facing
Ceramic crowns.
Bonded
Resin based
Composite based
Natural tooth.
RESTORATION OF SEVERELY
DECAYED TOOTH WITH POST
AND CORE
22
FULL CORONAL
RESTORATIONS IN CHILDREN
Crowns can be made from:
All metal
Metal crown with facing
All ceramic
All resin preformed plastic crowns
Composite based crowns.
Composite-based Crowns
COMPOSITION OF CROWNS
23
24
25
26
Indications
Caries (Figs 3.1A and B)
Objectives
Characteristics of
Stainless Steel Crown
B
FIGURES 3.1A AND B Rampant caries affecting primary incisors and molars
Hypoplastic Defects
Teeth with hypoplastic defects are more susceptible to caries, because retention of the plaque
occurs in hypoplastic defects (Figs 3.3A to C).
The placement of stainless steel crowns in
hypoplastic teeth, treatment may involve the
crowning of the teeth in all 4 quadrants (often all
posterior teeth). Thus there is danger of altering
the vertical dimensions by impinging on the
freeway space. In such cases the crown should
be fitted quadrant wise.
As a Preventive Restoration
Extensive Abrasion
Developmental Defects
Primary or permanent teeth with enamel
or dentin defects such as, amelogenesis
imperfecta, dentinogenesis imperfecta and
hypoplastic teeth. In these developmental
defects, enamel is chipped or worn off
exposing the underlying dentin, which leads to
reduction in vertical height of the crown hence
SSC is advised to restore occlusal height and
strengthen the tooth. In these cases, crowns
27
28
As an Abutment/Space Maintainer
Bruxism
In severe cases of bruxism, teeth may be so
abraded and severely worn (Fig. 3.5) so that
stainless steel crowns are required to restore
the interarch vertical dimension and prevent
traumatic pulpal exposure. In the mixed
dentition phase, the stainless steel crown
adapted to the primary molars will assist in
preventing wear of the first permanent molars.
Cross-bite Correction
Correction of anterior cross-bite or to alter the
shape, size or inclination of teeth, a large sized
anterior SSC placed in reverse position on
maxillary anterior tooth (Fig. 3.6).
Contraindications
Even though preformed crowns have been advocated for use in other circumstances, they are
not the preferred restoration for:
Advantages
Unbreakable
Crown completely covers the tooth and no
enamel is left exposed to decay/full coronal
restoration
Durable
Inexpensive
Minimal technique sensitivity
Pretrimmed, contoured and crimped
crowns needs minimal adjustment
Accurately duplicates tooth anatomy
Faster placement
Can be placed in presence of gingival
hemorrhage or moisture
Superior longevity compared to multisurface amalgam fillings.
29
30
Studies Pertaining to
Stainless Steel Crown Uses
Esthetic and Parental Satisfaction
Several studies stated unacceptance of SSC by
parents as concerned to esthetic aspect. Esthetic
Multisurface amalgam
Number placed
Failures %
Number placed
Failures %
Braff, 1975
Dwason et al. 1981
Masser/Levering, 1988
150
102
1177
87%
71%
22%
76
64
331
25%
13%
12%
706
12%
673
2%
10
66
58%
66
6%
Raw
Randall, 2002
Papathanasio, 1994
2201
2201
26%
1210
1210
7%
5
210
30%
PMC crown
Study duration
20%
Years
2.5
2
5
Disadvantages
FIGURES 3.7A TO C Different metal crownsSSC (Uniteck), nickel-based (3M), tin-based (Iso-Form) crowns
31
32
Based on Morphology/Shape
(Figs 3.9 A to C)
Based on Sizes
Classification of stainless steel crowns based on
sizes is shown in Table 3.2.
Number of
sizes available
Width range
(mm)
6 (27)
7.29.2
Upper 2nd
primary molar
6 (27)
9.211.2
6 (27)
7.49.4
Lower 2nd
primary molar
6 (27)
9.411.4
Upper 1st
permanent molar
6 (27)
10.712.8
Lower 1st
permanent molar
6 (27)
10.812.8
6.69.0
Upper 2nd
primary molar
8.511.0
6.99.3
Lower 2nd
primary molar
8.511.5
Commercial Products
Various commercial SSC refill crowns can be
ordered using various order forms (Figs 6.1 to
6.5).
33
34
Features
Shallow occlusal anatomy requiring less
occlusal reduction.
Pretrimming to optimum length and
contour.
Parallel walls to provide broad, flat contact
points for easy fitting.
Number
of sizes
Width range
available (mm)
6.48.5
6.08.0
6.68.5
6.89.0
10.312.0
9.010.5
Kits
ND-96: Intro kit-96 crowns. Set box only: ND-000
11.112.4
9.811.6
Primary Molars
There are 80 crown sizes available in the 3M
ESPE Unitek stainless steel primary molar
crown.
Kits
908100: Primary anterior set-72 crowns. Set box
only: PA-000
902150: Primary molar set-112 crowns. Set box
only: PR-000
Availability for Permanent Molars
There are 24 crown sizes available in the 3M
ESPE stainless steel permanent molar crown
range.
Nickel-chromium Crowns
Kits
PO-96: Intro kit-96 crowns. Set box only: PO-000
Permanent Molars
There are 82 crown sizes available in the 3M
ESPE Unitek stainless steel permanent molar
crown range.
Kits
902600: Bicuspid set-84 crowns. Set box only:
SB-000
902350: Molar set-84 crowns. Set box only: PM000
Selection of crown
Procedure of tooth preparation and crown
adaptation
Occlusal evaluation
Local anesthesia
Rubber dam isolation
Wedging
Removal of caries
Tooth preparationocclusal, proximal
and buccal/lingual surface reduction,
final finishing
Crown adaptationtrimming, crimping,
contouring, finishing and polishing
Cementation and final evaluation of
occlusion.
Preoperative Procedures
Dental age of the patient: This is recorded by
the root development of the underlying tooth
when a primary tooth can be expected to
exfoliate within 2 years of restoration following
crown placement. However, failure of extensive
amalgam restoration in the primary teeth can
be frustrating. This can be overcome by an initial
placement of stainless steel crown.
Cooperation of the patient: If the patient is
uncooperative, whether it is due to age (i.e. < 3
years) or due to negative behavior, if the child is
stubborn and does not want to cooperate, firstly
by a positive behavior has to be installed. If child
is unable to cooperate, then treatment under
conscious sedation and general anesthesia may
have to be considered. It is difficult to check
the correct occlusion so it is always better to
keep stainless steel crown at the level or slightly
below the level of the adjacent tooth, so that the
child does not have disturbed occlusion due to
premature contact.
Medically compromised/disabled children:
Children especially suffering from heart
problems should have prophylactic antibiotic
cover to safeguard against any subgingival injury
during tooth preparation. In case of medically
Armamentarium
Burs and stones
No. 169L or No. 69L F.G.
No. 6 or No. 8 R.A.
No. 330 F.G.
Tapered diamond F.G.
Round bur for caries removal
Flame shaped diamond bur or round end
tapered bur for occlusal reduction
Long thin tapered bur for proximal, buccal
or lingual reduction
Others
Rough or whitening polish wheels.
Sharp scalars or instruments, America No.7.
Green stone or heatless stone/rubber wheel
stone for finishing and polishing rough
polishing wheel
Wire wheel for finishing crown
Cement medium
Glass slab, cement mixing pad
Spatula/Agate spatula
Zinc phosphate, zinc oxide eugenol, GIC
or zinc polycarboxylate cements
Dental floss
Rubber dam armamentarium
Sharp explorer for marking gingival extension of crown margin.
Pliers and instruments (Table 3.4, Fig. 2.8
and 3.10)
Selection of Crown
Manufacturers: 3M ESPE, Denovo Baldwin,
Park,Calif , Hu-Friedy Pedo crown, Kids crown
SSC crown availability: Various commercial
SSC products are available in the market
(Fig. 3.11). Stainless steel crowns are available
in 6 sizes for each primary tooth separately
for individual teeth size 2 to 6 (Fig. 3.12). Sizes
35
36
Nomenclature of pliers
Use of pliers
no 114
Gordon plier
no 137
no 800-417
no 112
Howe plier
no 110
Reynold plier
Contouring
Curved Howe
no. 111
FIGURE 3.10 List of pliers for crown adaptation (from left to rightReynold, Gordon, ball and socket, Jonson,
crimping, straight Howe, curved Howe pliers)
37
38
Anesthesia
To eliminate the discomfort caused by cutting
the tooth and possible trauma to the soft tissues
during the trial fitting of stainless steel crown,
there must be adequate anesthesia of the tooth
and the adjacent soft tissues.
Anesthetize the tooth to be treated to
prevent pain and to avoid discomfort to child
since gingival tissues all around the tooth may
be manipulated during crown placement. It
is necessary to obtain adequate anesthesia of
buccal, lingual or palatal surfaces. In the lower
arch, use an inferior alveolar nerve block,
supplemented by an infiltration of the long
buccal nerve. In the maxilla, an infiltration
on the buccal and occasionally on the palatal
side of the tooth are required if pulp therapy
is planned. It is not necessary to place the
anesthetic solution on the palatal side over
the apex of the tooth. It can be placed in the
loose soft tissues adjacent to the tooth from the
buccal side after anesthetic solution has begun
to produce anesthesia (Wei SHY, 1988).
Isolation
Use of rubber dam is indicated wherever
possible for isolation is mandatory. When it
is not possible to use rubber dam, as in case
of terminal teeth in arch, cotton rolls, which
are held in position by cotton roll retainer or a
gauze oral screen should be used to prevent the
possible aspiration of a crown.
Use a rubber dam in preparing a tooth for
a stainless steel crown for the following
reasons:
To protect surrounding tissue
To improve visibility and efficiency
Caries Removal
Caries can be removed either before or after tooth
reduction. Remove the decay with large round
bur in a slow speed hand piece. After removing
caries perform pulp therapy if necessary. The
previously carious area can be built up with.
GIC cement. Restore endodontically treated
tooth with GIC before tooth preparation.
Wedging
A wooden wedge may be placed tightly between
the surface being reduced and the adjacent
surface to provide a slight separation between
the teeth for better access and to reduce risk of
iatrogenic damage to adjacent teeth. It also helps
to depress the gingival tissue and rubber dam.
REDUCTION OF TOOTH
Occlusal Reduction
Occlusal reduction should be done to provide
space for SSC crown and should be done before
proximal reduction to avoid invisibility of preparation areas due to blood contamination.
Full et al. (1974) considered that occlusal
preparation should be done first to allow better
access to the proximal areas of the tooth. While
other authors suggest the proximal reduction
before the occlusal surface. Gingival bleeding
will occur if the proximal reduction is done at
39
40
FIGURES 3.13A TO L (Case-1) SSC adaptation procedure: (A) Preoperative occlusion; (B) Measurement of tooth
dimension; (C and D) Crown selection; (E) Occlusion reduction; (F) Proximal reduction; (G) Crown fitting linguobuccaly; (H) Marking gingival extension; (I) Contouring; (J) Crimping, (K) Radiographic evaluation; (L) Final fitting
of crown
Year
Occlusal reduction
in mm
Humphrey
1950
Mink and
Bennet
Mathewson
et al.
Troutman
and Kennedy
Rapp
1968
1974
Cups should be
reduced if necessary
11.5 mm uniform
reduction
11.5 mm
1976
1.52 mm
1966
Preparation
height
4 mm from gingival
margin
3
4
5
Proximal Reduction
The proximal contact needs to be cleared for
two reasons:
1. Caries starts at or beneath the contact area
It has been observed that many of the difficulties encountered in placing a stainless steel
crown are the result of attempting to fit a
round or oval crown form over a rectangular
tooth preparation. Irregularities, projections,
or sharp angle on the circumference of the
prepared tooth will prevent the crown form
from being properly seated, will cause timeconsuming repeated adjustments, and will
prevent the crown from properly fitting the
tooth preparation.
The primary principle of the technique
for fitting stainless steel crowns is to make
the tooth preparation to fit the crown form
rather than attempt to make the crown
fit the tooth preparation. By examining
the crown form, prior to preparation
of the tooth, one should see that the
crowns of all manufactures are somewhat
oval and rhomboid. This conforms to
the rhomboid shape of the primary tooth. In
41
42
Finishing
Beveling
CROWN ADAPTATION
43
44
45
46
Crown Finishing
It is safe to say that retention problems do not
cause failure of the steel restoration; most
failures result from poor and inadequate
preparation, improper gingival adaptation, and
the inability to properly visualize and determine
the relationship of the crown margin to the
margin of the preparation. This being the case,
it is incumbent on each practitioner to pay more
attention to this area of crown restoration so
that gingival irritation around the margin of the
crowns will not occur.
Large green stone is used to make knife edge
finish at the cervical margin of crown
Bur is moved in counterclockwise direction
at 45 degree angle
Then rubber wheel is used to smoothen
margins
Crown can be polished using Iron rouge
The final step before cementation is to
produce beveled gingival margin that may
be polished.
47
48
Crown Fit
Method to Determine Adequate
Crown Fit
Even though clinical adaptation and
appearance of stainless steel crown is good but
radiographic extension of the crown extension
is variable with ragged margins (Fig. 3.13K). To
avoid these discrepancies, Spedding, in 1984,
proposed two principles based on morphology
of primary teeth and gingival contour. Before
cementation, a bite-wing is taken to verify
proximal marginal integrity. If the crown is
too long, there is still an opportunity to reduce
the length. If it is too short, then add weld and
solder an orthodontic band or adaptation of
another crown is indicated. If there is any doubt
about the fit of the crown, a radiograph may be
taken after cementation (Figs 3.13K and 3.14B);
however routine radiographs of all patients to
determine the fit of all stainless steel crowns
are not justified. To amend these discrepancies,
Henderson proposed two principles based on
the morphology of primary teeth and gingival
contour. The following briefly outline his suggested method:
Principle 1: When primary molars are viewed
from either proximal surface, the buccal and
Crown Retention
Humphrey (1950) and Full et al. (1974) suggested that retention of stainless steel crowns is
related to minimal tooth reduction and contact
between the margins of the crown and the tooth.
Elastic deformation of the stainless steel crown
as it seats into undercut areas of the primary
teeth further enhances the retention. Although
laboratory research has determined that cement
is a very important factor in crown retention.
Savide et al. (1979) compared five different
types of preparations for retention capabilities:
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50
Crown Cementation
(Figs 3.14B and C)
Cementation of crown is depends upon the
pulpal status. Cavity varnish should be applied
first if the tooth is vital. GIC is most commonly
used cement for cementing crown. Mathewson
(1979) stated that retention of SSC crown is
due to cementing medium rather than due
to mechanical adaptation. Saved et al. (1979)
concluded from his study that, noncemented
preparations demonstrated only little mechanical retention and retentive values increased
following cementation in all the preperations.
Mechanical retention can be established using
buccal cervical bulge of tooth. Hence, proper
cementation should be done for success of
crown.
Following cements can be used for crown
cementation:
Zinc oxide eugenol
Zinc phosphate
Zinc silicophosphate
Polycarboxylate
Glass ionomer
Resin modified glass ionomer
Acrylic resin
Composite resin.
RESPONSE OF GINGIVAL
TISSUES TO STAINLESS STEEL
CROWN RESTORATION
Goto (1970) reported incidence of gingivitis in
primary teeth restored with nickel chromium
crowns. He found higher percentage of gingivitis in the posterior part of the mouth than
anterior and strongly associated with poor
fitting of crown. He observed clinically and
radiographically that crowns classified as
failure showed 33 percent gingivitis, while those
classified as good showed 13 percent and those
rated fairly good showed 25 percent. Whereas
Webber (1974) found no adverse effect on
gingiva with PMC crowns.
Myers (1975) published a clinical study on
the response of gingival tissues to steel crown
restoration, concluding that the lower incidence
of gingivitis around crown without defects
in the margins may be due to the fact that
these crowns are less likely to allow plaque to
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52
Precautions
Sterilization of Crown
53
54
E
FIGURES 3.17A TO E Stainless steel crown on adjacent teeth
B
A
55
56
B
FIGURES 3.23A AND B Management in bruxism/hypoplastic teeth
57
58
Advantages
Disadvantages
Indications
FIGURES 3.24A TO F Restoration of carious tooth by Hall technique (proximal space creation with orthodontic
separators followed by SSC crown placement)
59
60
Clinical Tips
Complications
61
62
Indications
Extensive caries: The use of a preformed
stainless steel crown restoration is indicated,
where the extensive carious destruction of
a posterior tooth in which caries control is
indicated, but retention of the temporary
filling material is uncertain, where gross
carious destruction of a posterior tooth for
which alloy restoration is contraindicated
because of pulpal considerations.
As temporary restoration: As a semipermanent restoration until a cast or
ceramic facing restoration is placed.
Teeth defects: For full coverage in young
posterior teeth that have enamel or dentinal
abnormalities.
Endodontic aspect: For restoration of a
tooth during endodontic treatment in which
access is made through the occlusal surface
of the steel crown.
The objectives sought in the use of the
stainless steel crown procedure are identical
to those of any restorative dental treatment.
Not only the occlusion be recreated ideally for
the patient but, in addition, proximal contact,
where indicated, must also be established. The
overall tooth architecture must be restored to
be physiologically acceptable and to preserve
masticatory function and periodontal integrity.
Procedure
The procedure consists of radiological considerations, administration of the anesthesia,
occlusal considerations before preparation of
B
FIGURES 3.27A AND B The SSC adaptation on permanent molar
63
64
65
66
Nickel Allergy
Nickel containing alloys have been used in
orthodontic appliances from past 35 years.
Nickel ions released in sufficient quantities
from nickel-containing alloys may induce
nickel sensitization or elicit allergic contact
dermatitis. Nickel chromium crowns are
having significantly higher percentage of nickel
(70%) compared to stainless steel crowns,
orthodontic bands and wires (912% nickel).
Nickel hypersensitivity is more prevalent in
females than males, which is in association with
ear piercing. Higher concentration of contact
allergen may be required to elicit response from
oral mucosa compared to skin. It is difficult to
evaluate nickel release into the oral cavity.
Several studies had shown the nickel allergy
with crown having higher percentage of nickel.
Feasby et al. (1988) reported an increased
nickel-positive patch test in children aged
8 to 12 years, who had received old formulation
ANTERIOR STAINLESS
STEEL CROWNS
Stainless steel crown for restoring anterior teeth
(Figs 3.28A and B) is not used nowadays, rather
SSC with facing are used for better esthetic
results. The tooth preparation is similar for
incisor. Stainless steel crowns were for many
years the only quick and effective means of
restoring fractured permanent incisor teeth on
a semi permanent basis. These crowns were
criticized because of poor esthetics and have
now largely been replaced by acid-etch retained
composite resin restorations. One of the roles
of an anterior stainless steel crown, that of
retaining a temporary dressing on the fracture
site, can be achieved satisfactorily by using
composite resin and the acid etch technique.
However, the major attribute of the stainless
FIGURES 3.28A AND B Anterior primary stainless steel crowns. (A) Anerior and posterior SSC;
(B) Anterior SSC refill box; (C) Antertior SSC
67
68
Manufacturers of Anterior
Stainless Steel Crowns
3M Espe-Unitek Crowns, St Paul, MN and Acero
Crowns, Seattle, WA., Rocky Mountain crown.
Stage 1
The first stage in the preparation of the fracture
incisor to receive a stainless steel crown is
the measurement of the tooths mesiodistal
dimension to facilitate selection of the crown of
the correct size. If there is no space between the
fractured teeth, a small proximal slice is required
to allow the fitting of the crown. The stainless
steel crown is usually too long, and therefore,
marking the gingival margin and trimming it in
the manner described for the posterior stainless
steel crown is necessary. This process must be
repeated until the correct cervical contour has
been obtained.
Esthetics: Reasonable esthetics can be achieved
followed by cutting a labial window in the
stainless steel crown. This can be done using
a diamond bur in an air turbine to cut away
the excess and finally a green stone to finish
the margins. Some material must be left to lap
around on the labial surface of the tooth, or the
crown will be easily displaced.
Stage 2
The next stage is to shape the cingulum with the
No. 112 pilers to avoid creation of an occlusal
interference. Retention in the form of a snap
BIBLIOGRAPHY
1. Albers JH. Use of preformed stainless steel crowns
in pedodontics. Quint. Int. 1979;10(6):35-40.
2. American Academy of Pediatric Dentistry
Reference manual, 1992-93. Guidelines for
management of the developing dentition in
pediatric dentistry, Chicago; 1992. pp. 46-9.
3. Beemer RL, Ferracane JL, Howard HE.
Orthodontic band retention on primary molar
stainless steel crowns. Pediatr Dent. 1993;15:6.
4. Bigsby BG, DMD, Tunison M. Comprehensive
Dental Care for Children, Adolescents and Challenged people. http://www.valleydentalpediatrics.com/crowns.php.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
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ALUMINUM CROWNS
Aluminum crowns are temporary crowns used
for bicuspids (Figs 3.29A and B). These crowns
have anatomical occlusal surfaces and toothshaped cross-sections (not cylindrical). They are
much easy to adapt to the preparation without
time-consuming in axial shaping. The larger
sizes measures a full 11 mm, to cover and protect
the tooth margin (Fig. 3.29C). A posterior tooth
can be protected by an aluminum provisional
crown. Cementation of crown can be done with
IRM or zinc oxide eugenol (ZOE) cement (Figs
3.29D and E).
Availability of Crown
They come in nine sizes for molars and
bicuspids, coded to the standard copperband numbering system. The introductory kit
includes a compartmented tray makes selection
easy (Fig. 3.29A). Each crown is stamped with
the size and quadrant to avoid confusion. Single
aluminum crown costs $ 1.90 while 60 bicuspid
crown kit costs $ 35. Available as BL, BU, ML,
MU, sizes 4 to 12.
for a short time, unless it can again be relined with acrylic resin for added strength. 3M
ESPE Gold Anodized crowns are made from
a medium-hard aluminum for durability and
function. Gold anodization eliminates metallic
taste and galvanic shock for greater patient
comfort.
Commercial
Anodized.
product:
3M/Unitek Gold
Features
Select the crown before tooth preparation. Tooth preparation is similar as for SSC. After selecting
appropriate size crown, try it on the tooth to make sure the distance between contacts is correct.
2.
See how much is necessary to trim at the gingiva. If the crown is 2 mm above the adjacent teeth, then
trim 2 mm all around at the gingiva using a crown scissors. It is important to trim in a smooth manner so
as not to leave sharp or uneven edges that can irritate the gingiva.
3.
Use crimping pliers to crimp the margins of the crown inward (Contouring pliers Nos. 112, 114 and 115
are most common). Use the contouring pliers for adapting the crown to the finish line. It is possible
to omit the contouring and reline the shell with methylmethacrylate (self curing acrylic). This will give
a better internal fit and more exact margins and is probably preferable since it helps to avoid a metal
overhang.
4.
Once the crown is seated on the prepared tooth, instruct the patient to bite down normally. This helps to
establish an initial occlusal anatomy onto the soft aluminum shell.
5.
Further check the occlusion with articulating paper and make adjustments.
6.
Check crown for rough metal margins. These can be smoothed using sandpaper, discs or a rubber wheel.
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B
FIGURES 3.30A AND B A. Gold anodized crown; B. Gold anodized refil box
5.69.1
5.69.1
5.78.6
6.29.1
9.411.9
9.411.9
9.912.4
9.612.2
Kits
942501: Bicuspid set-84 crowns
942301: Molar set-84 crowns
Set box only: GB-000-BicuspidGB-000Molar
BIBLIOGRAPHY
1. h t t p : / / w w w . p a r k e l l . c o m / p ro d u c t s / 4 0 2 /
Aluminum-Crowns
Window Preparation
A window is now placed in the facial surface of
the crown. A No. 330 or No. 245 bur is used to
cut the rough window. The window is refined
incisally with a No. 35 diamond disk in a slowspeed handpiece. The incisal portion of the
window is reduced in order to allow a 0.5 mm
undercut, while keeping the margin as straight
as possible. The esthetics of the finished crown
is improved with a straight incisal surface,
which is parallel to the incisal surfaces of the
adjoining teeth.
Insertion of Composite
After etching, cleaning and drying the prepared
window, apply bonding agent, cure it. Then
selected composite resin is inserted with a
syringe. The injection begins by filling the
gingival channel and continues up to proximal
surface. The incisal undercut is then filled,
followed by the other proximal surface. This
method will ensure that the entire retention
area has been filled with composite. Filling the
central portion of the window completes the
resin injection. A premier cervical matrix form
No. 722 G is then used because it contours well
to the margins of the window and establishes
a good facial contour. The matrix is slipped 1
mm beneath the tissue with a cotton forceps
and then gently passed toward the crown with
finger pressure until all margins are contacted.
It is then held in place until the composite
is set.
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COMPOSITE VENEERING OF
PRIMARY MOLAR SSC
Tooth preparation and crown placement is
similar to that of SSC as mentioned above.
Only difference is that, after crown
cementation, window is prepared on buccal
side of crown to provide place for placement of
composite facing. Leave thin margin of stainless
steel crown at gingival part on buccal surface.
After composite shade selection, etch the
tooth surface, wash it then apply bonding agent
followed by composite material application
in layer, curing and finishing to form SSC with
facing (Figs 3.31A to F).
Advantages
Inexpensive
Durable
Easy to do
Well adapted to tooth
Esthetically pleasing.
Disadvantages
Isolation and hemorrhage control is difficult
Difficulty to avoid blood and saliva contamination since composite facing is done
Requires extra chairside time
Less than optimal esthetic
Metals may appear at the gingival edge of
the crown.
Weidenfeld et al. (1995) from their clinical
study concluded that chairside veneering
technique is successful for restoring severely
damaged primary anteriors and the resulting
veneer maintain the adaptability, strength and
gingival contour with cosmetic effect. AI-Shala
et al. (1997) conducted a study to determine the
in vitro bond strengths of composite rebonded
to stainless steel crown metal (SS) using five
different bonding agents (Scotchbond All-Bond
TM, Caulk TM, Ellman TM). Later composite to
SS bond failure had been produced. The main
conclusions of this study were:
Composite can be bonded effectively to SS
metal using a bonding agent.
BIBLIOGRAPHY
1. AI-Shala TA, Till MJ, Feiga RJ. Composit bonding
to stainless steel metal using different bonding
agents. Ped Dent.1997;19(4):273-6.
2. Waggoner WF. Restoring anterior teeth. Ped Dent.
2002;24(5):511-6.
3. Wiedenfeld KR, Draugh RA, Goltra SE. Chairside
veneering of composite resin to anterior stainless
steel crowns: another look. ASDC J Dent Child.
1995;62(4):270-3.
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Commercial Products
Availability
There are 16 crown sizes available in the 3M
ESPE pediatric strip crown range. Tables 3.7
and 3.8 show the features of commercial strip
crowns and sizes. Strip crowns can be ordered
using crown order forms (Figs 6.2 and 6.7).
Kits
915100: Intro kit-60 upper centrals 60 upper
laterals
Set box only: PS-000
Indications
Interproximal caries, excess or multisurface
caries on primary anterior teeth.
Following pulp therapy to primary anterior
teeth.
Restoration of fractured anterior teeth.
Incisors with hypoplastic defects, amelogenesis imperfecta.
Discolored incisors.
Congenitally malformed primary incisor.
Contraindications
Insufficient tooth structure for retention.
Deep overbite
Clear
Anterior and posterior
120
Crowns
Special features
Ideal for ankylosed tooth buildups, crystal clear and very thin
8
8
6.08.1
4.36.7
77
78
Bruxism
Periodontal diseases.
Benefits
Parent/patient pleasing
Ideal for ankylosed tooth buildups
Simple to fit and trim
Removal is fast and 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 celluloid crowns
Large selection of size
Easy to repair
Crowns are cost-effective (approximately $6/
crown)
Esthetic but more fragile than SSC
Better retention than poly carbonate crown
Functionally, allows occlusal wear
Require removal of small amount of tooth
structure
Automatically contours restorative material
to match natural dentition
Strips off easily leaving a smooth surface
Thin interproximal walls
Sufficient strength for easy handling
Ideal for chemical or light-cured composites.
Disadvantages
Moisture or blood contamination affects
resin bonding.
Time consuming procedure in young and
uncooperative
childadequate
tooth
structure required.
It is extremely technique sensitive.
It is not as durable or retentive as stainless
steel/open faced crowns, pre-veneered
crown or polycarbonate crown
It is not recommended on patients with a
bruxism habit or a deep bite.
Adequate moisture control might be difficult
on an uncooperative patient.
Armamentarium
Burs-taper fissure, inverted cone shaped bur
Curved crown and bridge scissor
Explorer
Dental floss
Rubber dam kit
Composite kit.
Preoperative Assessment
Check for incisor relation
Presence of remaining tooth structure
If remaining tooth structure is less then
consider for post and core followed by strip
crown
Cooperativeness of childif child is uncooperative then crown placement shold be
performed under conscious sedation or GA.
79
80
81
82
B
FIGURES 3.33A AND B Strip crown case-2
B
FIGURES 3.34A AND B Strip crown case-3
B
FIGURES 3.35A AND B Strip crown case-4
Disadvantages
Advantages
83
84
Manufacturers
Success, essentials, space maintainers laboratory.
Availability
Advantages
Disadvantages
Advantages
Disadvantage
Lack of strength.
POLYCARBONATE CROWN
BIBLIOGRAPHY
1. Kupietzky, Waggoner WF, Galea J. The clinical and
radiographic success of bonded resin composite
strip crowns for primary incisors. Ped Dent.
2003;25(6):577-81.
2. Kupietzky A, Waggoner WF. Parental satisfaction
with bonded resin composit strip crowns for
primary incisors. Pediatr Dent. 2004;26(4):33-7.
3. Kupietzky A. Bonded resin composite strip crowns
for primary incisors: clinical tips for a successful
outcome. Pediatr Dent. 2002;24(2):145-8.
4. Kupietzy A, Waggoner WF, Galea J. Long-term
photographic and radiographic assessment of
bonded resin composite strip crowns for primary
incisors: Results after 3 years. Pediatr Dent.
2005;27(3):221-5.
5. Margolis FS. The sandwich technique and
strip crowns: an esthetic restoration for
primary incisors. Compend Contin Educ Dent.
2002;23(12):1165-9;quiz 1170.
6. Murthy PS, Deshmukh S. Indirect composite
shell crown: An esthetic restorative option for
mutilated primary anterior teeth. Journal of
Advanced Oral Research. 2013;4(1):1-4.
7. Ram D, Fuks AB. Clinical performance of resinbonded composite strip crowns in primary
incisors: a retrospective study. Int J Paediatr
Dent. 2006;16(1):49-54.
8. Sahana S, Vasa AAK, Skhar R. Esthetic crowns for
primary teeth: a review. Annals and Essences of
Dentistry. 2010;2(2):87-93.
9. Steven Schwartz. Full Coverage Aesthetic
Restoration of Anterior Primary Teeth. http://
www.dentalcare.com/en-US/dental-education/
continuingeducation/ce379/ce379.aspx?Modul
eName=coursecontentandPartID=6andSection
ID=-1
10. Tate AR, Ng MW, Needleman HL, Acs G. Failure
rates of restorative procedures following dental
rehabilitation under general anesthesia. Pediatr
Dent. 2002;24:69-71.
Kudo crowns
Art glass crowns
Pedo jacket crowns
PedoNatural crowns (Fig. 3.39).
Manufacturers of Polycarbonate
Crowns
3M ESPE
Direct dental products
Sweedish dental supplies Lab (SWE Den)
PedoNatural crowns, Valencia CA
CrestOral-B.
Sizes
Available in
mm
7.710.1
5.87.6
Lower incisors
10
4.96.3
Cuspids
7.59.0
Bicuspids
10
6.27.5
85
86
Discolored teeth
Endodontically treated teeth.
Contraindications
Bruxism
Inadequate spacing
Anterior crowding
Teeth with excessive abrasion
Deep overbite
Evidence of abrasion in anterior teeth.
Advantages
Indications
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KUDOS CROWNS
Kudos crowns (temporary pediatric crowns) are
newer generation polycarbonate crowns. It is
easy to use and handle along with considerably
reducing the chairside working time and at the
same time overcomes the difficulties reported so
far pertaining to placement and retention. It is
more user friendly and esthetically acceptable.
Figures 3.41A and B show commercial Kudos
crowns. Figures 3.42A and B show Kudos crown
preparation and postoperative placement.
B
FIGURES 3.42A AND B Kudos crown [Source: Karthik et al. (www.kudoscw.hk.in/images)]
Advantages
Esthetically acceptable
Less chairside time
Improved retention
Flexible
Better adaptability.
Disadvantages
Chances of breakage
Dislodgement
Discoloration.
Package includes:
1 F/F Regular Size Tmp C and B
1 F/F Large Size Tmp C and B
5ea 20 regular size single crowns
5ea 20 large size single crowns
A2, A3, C3 shades are available
200ea pediatric crowns + 4ea C and B per
pack.
Availability
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90
PEDONATURAL CROWN
Anju Bansal
The PedoNatural Crown is not a composite
restoration and is never used with composites.
All components of the PedoNatural Crown are
hydrophilic (moisture tolerant). The PedoNatural Crown is a polycarbonate crown unlike
any other polycarbonate application previously
available in pediatric dentistry. These are ultra
thin crown form that is: anatomically correct,
flexible, easy to fit, extremely strong, durable
and automatically correctable polycarbonate
crown form.
The materials that are used in creating the
PedoNatural Crown form have been in clinical
use since 1997. Originally designed as a method
of providing long-term provisional splinting for
crown and bridge patients, the technique was
adapted for use in the primary dentition and
successfully endured 3 years of clinical studies
as the PedoNatural Crown.
PedoNatural Crowns provide the clinician
with a superior esthetic alternative to the
Advantages
Trimmable.
Crimpable.
Anatomically correct shape and size.
Flexible.
Easy to fit.
Extremely strong and durable.
Superior marginal integrity.
Excellent retention.
High tensile strength.
Disadvantages
Tooth Preparation
Tooth preparation and crown adaptation differs
with PedoNatural Crown compared to SSC in
that it require more amount of tooth reduction
including buccal and lingual reduction.
Anesthetize the tooth
Isolate the tooth with rubber dam isolation
Select appropriate crown size
Begin tooth preparation with incisal or
occlusal reduction for minimum of 2 mm.
Proximal slice/reduction is done to break
the contact point to create adequate
clearance for crown placement. Remove all
remaining decay and perform any necessary
pulp tissue treatment. Reduce the labial
surface a minimum of 2 mm and place all
the margins subgingivally.
Crown Adaptation
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92
C
FIGURES 3.43A TO C PedoNatural Crown placement (polycarbonate crown) (Courtesy: Steven Schwartz)
Procedure
The PedoNatural Crown is fabricate chairside by filling he crown form with a especially
formulated hybrid acrylic material
93
94
Disadvantages
Advantages
Manufacturers
Success essential, Space maintainers laboratory.
Availability
Anterior crown sizes-D, E, F, G, L, U as 1-6
numbers.
Replacement crowns: 5 per box costs $16.00.
ARTGLASS CROWNS/
GLASTECH CROWNS
Availability
Artglass crowns are available in a single shade
with six sizes for the each anterior teeth.
Artglass is made up of bifunctional and
new multifunctional methacrylates. The
Artglass matrix has the ability to form threedimensional molecular networks with a highly
cross-linked structure. Such highly crosslinked, amorphous organic polymers are
known in the chemical literature as organic
glasses. The total filler content of Artglass
is only 75 percent (55% microglass and 20%
silica filler) but when the matrix is cured, the
amorphous, highly cross-linked organic glass
Features
B
FIGURES 3.46A and B Artglass crowns
95
96
Disadvantage
Crown failure is usually due to result of bond
failure.
BIBLIOGRAPHY
1. American Academy of Pediatric Dentistry.
Pediatric Dentistry Reference Manual, vol. 31
(60), 40-46, 2009-10.
2. http://www.pedonaturalcrown.com.
3. http://www.pedotoothdocs.com.
4. Karthik
Venkataraghavan,
John
Chan.
Polycarbonate Crowns for Primary teeth
Revisited Restorative options, Technique and
Case reports , www.kudoscw.com.hk.In.
5. Kopel HM, Batterman SC. The retentive ability
of various cementing agents for polycarbonate
crowns. ASDC J Dent Child. 1976;43(5):333-9.
97
98
Recommendations
Advantages
Esthetically pleasing
Less moisture sensitive
Durable
Less chairside time
Easy to place
Full coronal coverage
Parent satisfaction.
Disadvantages
99
100
BIBLIOGRAPHY
1. Carla Cohen. Pre-Veneered Stainless Steel
Crowns-An aesthetic alternative. 2012.pp.1-6.
www.dentaleconomics.com.
2. Fuks AB, Ram D, Eidelman E. Clinical performance
of esthetic posterior crowns in primary molars: a
pilot study. Ped Dent. 1999;21(7):445-8.
3. Guideline on Pediatric Restorative Dentistry.
REFERENCE MANUAL. Pediatric Dentistry.
2013;34(6):214-21.
4. Monica, Jung-Wei C, Joe OC. Veneer retention
of preveneered primary stainless steel crowns
after crimping. Journal of Dentistry for Children,
2008;4:44-7.
5. Rama D, Fuks AB, Eidelman E. Long-term
clinical performance of esthetic primary molar
crowns. Ped Dent. 2003;25(6):582-4.
6. Robers C, Lee JY, Wright JT. Clinical evaluation
of and parental satisfaction with resin-faced
stainless steel crowns. Ped Dent. 2001;23(1):28-31.
NuSMILE CROWNS
These are stainless steel crowns with the most
natural looking facing. These are anatomically
correct stainless steel crowns, are less technique
sensitive and offer excellent durability and color
stability. These crowns are having facing on
labial surface and metal portion on lingual side
for crimping to achieve better seal. NuSmile
crowns available as anterior and posterior
crowns. MacLean et al. (2007) and Jeanetterr
et al. (2007) concluded that NuSmile anterior
preveneered crowns (Figs 3.49 and 3.50) are
a clinically successful restoration for primary
incisors with early childhood caries.
Advantages
Disadvantages
NuSmile ZR Crowns
NuSmile Crown is
Available in Two Forms
1. NuSmile signature.
2. NuSmile ZR.
B
FIGURES 3.49 A AND B (A) NuSmile anterior primary crowns; (B) labial and lingual view
B
FIGURES 3.50A AND B NuSmile crownzirconia type
101
102
B
FIGURES 3.52A AND B Canine NuSmile crown
B
FIGURES 3.53A and B Primary molar NuSmile crown. B. Nusmile posterior crown after cementation
(Courtesy: www.dentaleconomics.com)
BIBLIOGRAPHY
1. Cohen C. Preveneered stainless steel crowns-an
aesthetic alternatiVe. 2012-01-01. http://www.
pdwg-ng.org/materials/anterior%20crowns.pdf
2. Jeanette MJK, Cariann CCE, Willium WF, Marcia
Dm, Paul C. Clinical outcomes for primary
anterior teeth treated with preveneered stainless
steel crowns. Ped Dent. 2007;5:377-81.
3. MacLean JK, Champagne CE, Waggoner
WF, Ditmyer MM, Casamassimo P. clinical
outcomes for primary anterior teeth treated with
preveneered stainless steel crowns. pediatr dent.
2007;29(5):377-81.
103
104
B
FIGURES 3.54A AND B Flex crowns (anterior and posterior)
16
White-faced
24
Pediatric crowns
Available in upper right and left
centrals and laterals, sizes 16.
Kit includes 1 of each size
Manufacturer
Success essential space maintainer laboratory.
Available for incisor and primary molars.
Available as left, right, upper and lower size
1 to 6.
Kit includes 1 of each size = 24 crowns
470-501-24 flex crowns costs for $ 396.
Single crown cost$ 12.50
BIBLIOGRAPHY
1. http://www.sourceonedental.com/products/
pediatric-flex-crowns-4.
Advantages
Disadvantages
105
106
Laterals
Cuspids
FIGURES 3.56A TO C Pedo Pearls (anterior and posterior); A. Anteriro pedo pearl crown;
B. Posterior pedo pearls crowns
Posterior Kit
Item number: 2002PP
36 maxillary posterior crowns
1st molars (sizes 3 to 5)
2nd molars (sizes 3 to 5)
Both left and right anatomies.
Complete Arch Kit
Figure 3.56A shows images of anterior pedo
pearls. Figure 3.56B indicates posterior pedo
pearl crowns.
BIBLIOGRAPHY
1. Anterior crowns used in children. Morenike
Ukpong. Dep of Paediatric Dentistry, Obafemi
AwolowoUniversity, Ile-Ife, Nigeria.
2. http://pedopearls.net/products.htm
3. Waggoner WF. Restoring primary anterior teeth.
Ped Dent. 2002;24(5):511-6.
CHENG CROWN
Cheng Crowns from Peter Cheng Orthodontic
Laboratories, Inc. made its public debut in 1987
to provide an esthetic alternative to stainless
steel crown. The crowns are named after the
president of the company 'Mr Peter Cheng'.
These are stainless steel pediatric anterior
crowns faced with a high quality composite,
mesh-based with a light cured composite. There
are no long-term clinical trials to assess the
durability of these crowns.
B
FIGURES 3.57A AND B (A) Cheng crown;
(B) Zirconia checng crown
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108
Posterior Crowns
Second primary molar crowns starter kit: 12
crowns, upper and lower, left and right, sizes
3 to 5 (one of each size) $400.00.
Primary molar crowns for left and right
upper and lower area available as sizes 2 to 7.
Figure 3.59 indicates Cheng crowns for primary
anterior and posterior teeth.
Benefits/Advantages
Commercial Company
Peter Cheng Orthodontic Laboratories, Inc.
Availability
It is available for the right and left central and
lateral as well as cuspids with 6 sizes.
Crown Sizes
Anterior Crowns
Centrals laterals and cuspids: Sizes (1 to 6) left
and right
Disadvantages
PEDO COMPU-CROWN
Available as Sizes
BIBLIOGRAPHY
1. Baker LH, Moon P, Mourino AP. Retention of
esthetic veneers on primary stainless steel crowns.
ASDC J of Dent for Children. 1996;63(3):185-9.
Benefits
Manufacturer
Whiter Biter Inc.
BIBLIOGRAPHY
1. Roberts C, Lee JY, awright JT. Clinical evaluation
of parental satisfaction with resin faced stainless
steel crowns. Pediatr Dent. 2001;23(1):28-31.
109
110
BIBLIOGRAPHY
1. http://www.appliancetherapy.com/Global_Center
/se/tools_product.aspx? pid=468andcategory=
DURA CROWNS
Dura crowns are pediatric white-faced crowns.
These crowns can be crimped labially and
lingually, can be easily trimmed with crown
scissors, easily festooned and has got a fullknife edge margin. If the facing chips or breaks
after placement, esthetic repair is difficult and
usually requires replacement of the crown.
Study has shown that these crowns with veneer
facings were significantly more retentive than
the non-veneered ones when cement and
crimping were combined. Table 3.12 indicates
features of Dura crowns.
Availability
Available as upper, right and left for centrals and
laterals with 6 sizes for each tooth Dura crowns
are available as anterior and posterior crowns
(Figs 3.62A and B).
TABLE 3.12 Features of dura crown
Shades available
White-faced crowns
Crown sizes
Anterior/Posterior
available
Quantity
Adjustable
Product number
Advantages
BIBLIOGRAPHY
1. www.pattersondental.com
ZIRKIZ CROWNS
Zirconia crowns are new, unique, esthetic
pediatric dental crowns available on the market
today. Zirconia crown has created a new
approach to restoring the natural appearance
of a childs smile with a minimally invasive
technique. Zirconia crowns have superior
111
112
Manufacturer
ZIRKIZ, HASS Corp; Korea.
Clinical Technique in
Crown Placement
B
FIGURES 3.63A TO C ZIRKIZ crown
BIBLIOGRAPHY
EZ-CROWN
EZ-pedos pioneering achievement is revolutionizing the appearance of pediatric dental
crowns and renewing happy and healthy smile
on pediatric patients. EZ-pedo company first
developed monolithic zirconia pedo crowns as
anterior and posterior crowns (Figs 3.64 and
3.65). EZ-pedo is the first company worldwide
to offer fully white, prefabricated, ceramic
crowns especially designed for children.
These crowns are made of solid zirconia, a
biocompatible material. It is composed entirely
of one solid tooth-colored material; they look
extremely esthetic, both from the front view
and on the inside of the mouth. Each crown
is glazed with a hint of natural color, making
them very smooth, shiny and impermeable to
staining. They are exceptionally strong, and
their unsurpassed esthetics allows them to
blend in seamlessly with surrounding natural
teeth. Tooth preparation for EZ-crown is similar
to that of SSC.
Development of EZ-Crown
In 2004, Hansens 3-year-old son, John Paul, fell
in the bathtub and seriously injured four of his
front teeth. Hansen sent his son to a pediatric
dentist to have the boys smile reconstructed
and was stunned to learn that there were no
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114
Manufacturing of EZ-Crowns
The zirconia crowns are first milled in an exoticlooking, custom-made machine (Fig. 3.67).
About 35 to 50 crowns placed in a disc can be
shaped simultaneously. From there, the crowns
will be smoothed, polished, put through a
staining solution, hardened in a 4,000-degree
chamber, microblasted and glazed. Every
crown gets a label, which can be scratched
off by a dentist before placement (Fig. 3.65).
There are 96 shapes and up to six sizes for each
specific tooth. Zirlock technology has been
implemented within the EZ-pedo crown to
improve retention (Fig. 3.68).
Advantages
Crown selection
Tooth preparation-on lingual , incisal, facial,
proximal surfaces
Checking for crown fit and crown cementation.
Figure 3.69 diagrammatically explains the
procedure of EZ-crown placement.
BIBLIOGRAPHY
1. http://www.ezpedo.com.
2. Waggoner WF. Restoring Primary Anterior Teeth.
Las Vegas, Nevada.
3. www.sunnysmileskids.com.
KINDER KROWNS
Kinder Krowns offer the most natural shades
and contour available for the pediatric patient.
Kinder Krowns are made available to market
from past 23 years. The great depth and vitality
115
116
Benefits
Features
117
118
Size
1.3
2
2.5
3
3.3
4
4.5
5
5.5
6
6.3
7
B
1
2
1
2
1
2
1
2
1
1
1
1
I
1
2
1
2
1
2
1
2
1
1
1
1
S
1
2
1
2
1
2
1
2
1
1
1
1
L
1
2
1
2
1
2
1
2
1
1
1
1
A
1
2
1
2
1
2
1
2
1
1
1
1
I
1
2
1
2
1
2
1
2
1
1
1
1
T
1
2
1
2
1
2
1
2
1
1
1
1
K
1
2
1
2
1
2
1
2
1
1
1
1
to back or significant space loss. The midsized crowns retain their buccal-lingual
width, while the mesial-distal has been
reduced to allow for easier placement.
Size
Centrals
Laterals
Product Description
36 Crowns
Centrals 2, 3, 4 (4 of each)
Laterals 3, 4, 5 (4 of each)
Centrals 1, 5, 6 (2 of each)
Laterals 1, 2, 6 (2 of each).
Cuspids
128 Crowns
Sizes: 1.5, 2.5, 2.5, 4.5, 5.5, 6, 6.5, 7 (1 of each B,
I, S, L, A, J, T, K).
Sizes: 2, 3, 4, 5 (2 of each B, I, S, L, A, J, T, K).
Manufacturer
Orthodontic technologies-Kinder Krown.
BIBLIOGRAPHY
1. http://www.kinderkrowns.com.
119
120
FIGURES 3.80A AND B A. Cerec crown-CAD CAM procedure; B. Computer generation cerec model
Disadvantages
BIBLIOGRAPHY
1. http://www.sirona.com/en/products/digitaldentistry/cerec-chairside-solutions/?tab=241.
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122
BIOLOGIC CROWN
In 1964 Chosak and Eildeman published the
first case report on reattachment of a fractured
incisor fragment, which was endodontically
treated by cast post and core. Fragment
reattachment using natural teeth is a technique
known as biologic restoration. The biologic
restoration meets the esthetic and standard
of natural teeth. Biological restorations are an
alternative treatment for primary teeth. Biologic
restorations are made from tooth fragments
selected from natural extracted teeth or from
a bank of tooth tissues and bonded with dualcure composite cement to prepared teeth.
Biologic post and core are made from natural
extracted teeth radicular dentin. Presence of
similar structure might enable to absorb and
dissipate stress. Biologic restoration using
natural post and core can provide natural
esthetics. Biologic post and core, crown and
veneer restoration are comparatively cheaper to
other esthetic materials. These restorations are
performed easily without need of sophisticated
equipment.
There are 2 methods of restoring tooth with
biologic restorations
1. Autogenous biological restoration-done
when fractured fragment is available in
satisfactory condition. Tooth fragment
obtained from the patient itself.
2. From donated extracted teeth. Tooth
fragment obtained from donor or tooth
bank. The biologic tooth can be obtained
from tooth bank where it is stored and
sterilized after thorough scaling and removal
of soft tissue, periodontal remnants, pupal
tissue from root canals. Teeth were kept at
40C in Hanks balanced salt solution with
donor identification like tooth parameters
such as dimensions, color, shape, size and
age. The combination of tooth fragment,
adhesive and restorative material provides
good functional and esthetic result. In case
LIMITATIONS
TOOTH PREPARATION
Prepare the coronal portion of tooth to receive
biologic crown (Fig. 3.84D).
FABRICATION OF
CROWN PORTION
FIGURES 3.84A to H Biologic restoration procedure. (A) Crown sectioning; (B) Biologic crown; (C) Tooth
preparation to receive biologic crown; (D and E) Trying biologic crown; (F) Radiographic evaluation of crown
adaptation; (G) Crown cementation; (H) Final radiographic evaluation of cemented biologic crown
[Source: Babaji P, et al. J Clin Diag Research. 2014;8(11):ZD11-13]
RADIOGRAPHIC EVALUATION
Benefits
CEMENTATION OF BIOLOGIC
CROWN
Retention comfortable
Esthetic as natural tooth
Natural enamel has physiologic wear
Superficial smoothness and cervical
adaptation compatible with those of the
surrounding teeth.
Avoids long clinical appointments
Avoids laborios technique
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124
Disadvantages
BIBLIOGRAPHY
1. Barcelos R, Neves AA, Primo L, de Biological
restorations as an alternative treatment for
primary posterior teeth. J Clin Pediatr Dent.
Summer. 2003;27(4):305-10.
2. Ribeiro Preto. Biological restorations as a
treatment option for primary molars with
extensive coronal destruction-report of two
cases. Braz Dent J. 2007;18(3):1-4.
3. Wadhwani KK, Hasija M, Meena B, Waghwa
D, Yadav R. Biological restorations: option
of reincarnation for severely destructed
teeth. Europian Journal of General Dentistry.
2013;2(1):62-6.
4. Babaji P, Khanna P, Shankar S, Chaurasia VR,
Masamatti VS. Biologic Restoration: a treatment
option for reconstruction of anterior teeth. JCDR.
2014;11:11-13.
C hapter
4
Restoration of Destructed Primary
Teeth with Post and Core
Prashant Babaji, Vishwajit Rampratap Chaurasia, Ranjithkumar Rampratap Chaurasia,
Vinaykumar S Masamatti, Vikram Shetty K
MANAGEMENT OF SEVERELY
DAMAGED TEETH
Extensive destruction of primary maxillary
anterior teeth occurs commonly in early
childhood caries. Endodontic treatment is
necessary in such teeth due to chances of pulpal
involvement prior to restoring with crown. In
extreme cases of early childhood caries, there is
total loss of the crown structure. Until recently,
the only treatment option in management of
early childhood caries has been extraction of
the affected primary anterior tooth, which has
severe coronal destruction.
Early childhood caries (ECC) (Fig 4.1A and
B) involves the upper anterior teeth early in
life and by the time child visits the dentist most
of the coronal structure would have been lost.
B
FIGURES 4.1A AND B Early childhood caries (ECC)
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126
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Factors in Selection of
Dowel Core and Post
Thickness of tooth structure around the
canal
Bulk and height of remaining supragingival
tooth structure
The diameter of the tooth
Root morphology
Bone support
Tooths role in the final restoration
Nature of resorption of primary tooth root.
Based on Fabrication
Direct method-metallic, fiber post (ready
made posts)
Indirect method-resin composite post,
custom made post
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Fiber Post
These posts are available commercially in
various diameter and length. Appropriate size
of post can be selected based on root canal
morphology of tooth to be restored for crown.
127
FIGURES 4.2A TO C Post space shapes (Mushroom, tapered and onion shapes)
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128
Metallic Post
These posts are made up of stainless steel
wire of 22 gauze/0.7 mm. It is very rigid, but
esthetic quality is compromised. The post
part of wire can be smooth or retention can be
increased with serration. Various designs are
made on coronal part of wire to build core part
to receive crown. Even though conventional
prefabricated metal posts is a fast, low-cost
and simple technique, but is not accepted in
pediatric dentistry because of the potential
interference with physiologic root resorption.
Orthodontic wire designs such as omega, alpha
and half omega can be designed (Figs 4.5 and
4.6). The use of stainless steel orthodontic wire
as an intracanal post has also been a simple and
fast technique for reconstruction of primary
anterior teeth. However, in most cases, the wire
adaptation to the internal walls of the canal is
not adequate, leading to detachment of the wire
and restoration or radicular fracture, especially
in cases with excessive masticatory forces.
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Omega-shaped Post
Advantages
Translucency
Resin composite crown reinforcement
Ease for manipulation.
Alpha Type
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129
Disadvantages of Posts
in Primary Teeth
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130
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131
FIGURE 4.8 Post and core case-2 (Fiber, reverse metal and omega-shaped posts)
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132
B
FIGURES 4.9 A AND B Fiber reinforced composite crown with artificial tooth (pontic)
[Source: Jain, et al. JISPPD. 2011;4(29):32732)]
04.indd 132
BIBLIOGRAPHY
1. Eshghin A, Esfahan RK, Khoroushi M. A simple
method for reconstruction of severely damaged
primary anterior teeth. Dental Research Journal.
2011;8(4):2215.
2. Jain M, Singla S, Bhushan BAK, Kumar S, Bhushan
A. Esthetic rehabilitation of anterior primary
teeth using polyethylene fiber with two different
approaches Journal of Indian Society of Pedodontics
and Preventive Dentistry. 2011;4(29):32732.
3. Leena Verma, Sidhi Passi. Glass Fibre-Reinforced
Composite Post and Core Used in Decayed
Primary Anterior Teeth: A Case Report. Case
Reports in Dentistry Volume 2011, Article ID
864254, 4 pages, 2011.doi:10.1155/2011/864254.
4. Mendes FM, De Benedetto MS, Del Conte
Zardetto, CG, Wanderley MT, Correa MSN. Resin
composite restoration in primary anterior teeth
using short-post technique and strip crowns:
A case report. Quintesence International.
2004;35(9):68992.
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C hapter
5
Management of Complications
Prashant Babaji, Senthilnathan S, Nitin Sharma, Suresh BS
CROWN TILT
Destruction of complete lingual or buccal wall
by caries or over instrumentation may result
in crown tilting towards deficient side. This
may result in finished crown tilting towards the
deficient side. Placement of an amalgam alloy
or GIC restoration prior to crowning provides
support to prevent crown tilt. The clinical
significance of crown tilting is minimal unless
it occurs on young permanent molars, where
supraeruption of the opponent tooth may occur.
INTERPROXIMAL LEDGE
A ledge (Fig. 5.1) will be produced instead
of a shoulder free interproximal slice, if
the angulation of the tapered fissure bur is
incorrect. Failure to remove this ledge will
result in difficulty in seating the crown. When
the adjacent tooth is partially erupted, and the
contact is poorly established, the interproximal
slice is difficult to prepare. To clear the contact
area, extensive subgingival tooth reduction
is required which may result in formation of a
ledge or damaging the erupting tooth. In such a
case, it may be advised to delay crowning until
contact areas are properly established.
Ledge can be avoided by extending the
slice subgingivally by holding the thin tapered
bur parallel to long axis of tooth and carefully
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134
05.indd 134
OVER EXTENSION
OF THE CROWN
Over extension of crown (Fig. 3.26B) can be
identified with gingival blanching, which can
leads to loss of periodontal attachment and
periodontal problems due to food lodgment.
This can be corrected by identifying the
adequate (1 mm) gingival extension of the
crown margin, scratching the line, trimming the
excess and crimping followed by polishing.
30-01-2015 17:22:25
Management of Complications
INGESTION/INHALATION
OF CROWN
Accidental ingestion of crown can occur due to
uncooperative behavior of child or negligence
from dentist.
Possible methods to prevent ingestion of
crown are:
Rubber dam for isolation till crown
cementation. It prevents accidental swallo
wing or aspiration of a crown.
Throat pack with gauze piece.
Floss attachment by means of impression
compound on the occlusal surface of the
crown is the preferred practice by some
clinicians.
135
Management
Immediately after ingestion of crown check
for its location in mouth.
Attempt to removal of ingested crown can
be made by holding the child upside down
as soon as possible.
Advice posteroanterior (PA) radiograph of
chest to check the presence/location of crown
(Fig. 5.2). If crown is not found in radio
graph, then assume its passage through
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136
OBSTRUCTED AIRWAY
IN CHILDREN
Perform the following steps when basic
procedures have proved ineffective:
05.indd 136
Attempt to Ventilate
Open the airway, using the head tilt-chin lift
technique (Figs 5.5A and B).
Attempt to ventilate.
If unsuccessful. Repeat the preceding steps
until successful.
Consider a surgical cricothyrotomy (Figs
5.6A and B) to establish airway in children
older than 3 years.
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Management of Complications
137
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Back Blows
Manual thrust
Chest thrust
Finger sweep.
If the crown is in bronchi or lung,
medical consultation will probably result in
attempt toremove it by bronchoscopy. The
presence of cough reflex in the conscious
child will reduce the chances of inhalation
and ingestion of the crown is more likely.
Ingestion is of less consequence, as the
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138
F
FIGURES 5.4A TO F Foreign body check in children mouth
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Management of Complications
139
B
FIGURES 5.6A AND B Cricothyrotomy procedure
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140
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BIBLIOGRAPHY
1. Stanley F Malamed. Medical emergency in
the dental office, 6th edition. Mosby Elsevier
Publication, 2012.
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C hapter
6
Tables and Charts
Prashant Babaji
Manufacturers
Phone
number
Starter
kit
Individual
crown
Additional
information
Disadvantages
NuSmile
Orthodontic
Technologies
18003465133
16 crowns
$ 260.00
Anterior
$17.98
Available in
different length
with resin facing
on SSC crown.
Crimp only on
lingual surface
Has Zirlock
technology
Autoclavable
Stain resistant
Expensive
Bulky
Not crimped
Anterior
$ 9.95
Posterior
$ 12.95
Lab-enhanced
composite resin
crown form
Cannot be
crimped
Anterior
$19.00
Posterior
$34.50
New
Space
Millennium Maintainers
crown
Laboratory
18004233270
24 crowns
(ant)
$ 290.00
12 crowns
(Post)
$ 169.50
Cheng
crowns
Peter Cheng
Orthodontic
Laboratory
18002886784
16 crowns
$ 280.00
Posterior
$35.00
Contd...
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142
Contd...
Crown
Manufacturers
Phone
number
Starter
kit
Individual
crown
Additional
information
Dura
crown
Space
Maintainers
Laboratory
18004233270
24 crowns
$ 396.00
Anterior
$16.50
May be crimped
on labial and
lingual, flexible
facing
attached to SSC
18004233270
96 crowns
(ant)
$ 219.00
Ant/post 5
for $12.50
Copolymer
Less durable
crown form one
shade
Crack and
stain proof
Ant/post
Has universal
anatomy.
Made up of
heavy gauze
aluminum
crown with
epoxy paint
coverage
Cost effective
24 first
molars
$ 64.50
Pedo Perls
Ant-36
crown $348
Post-36$322
72-$513.8
SSC
Flex crown
Pedo
compu
3M ESPE
Uniteck
48 crowns
primary
Ant/Post
Space
Maintainers
Laboratory
24 sizes,
$396,
single$12.5
Anter-R
and L
Coverage of
HDP material
can be crimped
and contoured,
squeezable
Ant-R, L
Primary/
Permanent
Disadvantages
Not crimpable
Relatively soft
Less durable
Contd...
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143
Contd...
Crown
Manufacturers
Phone
number
Starter
kit
Individual
crown
EZ crown
Kinder
Krown
Mayclin Dental
Studios
18005227883
Aluminum
crown gold
anodized
crown
Pearson Dental
Supplies
3M, Uniteck
60 bicuspid$35
Single$1.9
Strip
Crown
Space
Maintainers
Laboratory
18004233270
16 crowns
$ 259.00
96 crowns
(ant)
$ 210.00
48 first
molars
$ 116.00
48 second
molars
$ 116.00
06.indd 143
Anterior
$17.95
Ant/Post 5
for $11.00
Additional
information
Disadvantages
Zir-lock
technology for
retention
High strength
Not wears
opposing
teeth
eeds excess
n
tooth reduction
Different
lengths
available 2
shades
resin facing
on an
SSC crimp
only on lingual
surface
Excess tooth
reduction
Easy to adjust
Low strength
Unesthetic
Seamless
plastic crown
form without
long cervical
collars other
strip crowns
forms (3M) are
also available
through other
major dental
suppliers
Fractured
one can be
repaired
re technique
A
sensitive
Product Name
Manufacturer
Pedo Pearls, 6111 FM 1960 West Suite 215 Houston, TX 77069, USA
manufacturers
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Retention
depends on
remaining
amount of tooth
structure and
acid etching.
Can dislodge
upon traumatic
injury
Requires
more time
for isolation,
acid etching,
placement and
finishing
Durability
Time
consumption
Selection
criteria
Fastest crown to
place
Severely decayed
teeth
Need for durability
Active accident
prone child
Severe bruxism
Very good.
Good like SSC but
Crimped and
facing may be
cemented crowns dislodged
are very retentive
Poor
Very good
initially, may
discolor over a
period of time
Esthetics
SSC
Strip crown
Technique
Esthetic is
prime concern
Difficult
to control
hemorrhage
Time consuming
compared to
SSC
When esthetic is
prime concern
Faster crown
placement
good
Very good
Good
Ceramic/
Zirconia crown
Prefabricated
veneered SSC
Temporary
restoration
Time consuming
Poor
Average
Polycarbonate
crown
Contd...
When natural
preservation
esthetic
Cost
consideration
Acceptance
of biologic
tooth
fragment
Comparable
Average
Very good
Biologic
crown
144
Crowns in Pediatric Dentistry
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06.indd 145
Anterior and
posterior
3M ESPE
Technique
sensitive
Esthetic
Not technique
Repaired easily
sensitive
if fractured
Can be done
minimal tooth
structure
Types
Manufacturers
Disadvantages
Advantages
Unesthetic
3M ESPE
Untrimmed,
uncontoured
Pretrimmed
Recontoured
For anterior
and posterior
Can be crimped,
trimmed
Trimmed with
scissors
Crimping,
contouring,
trimming
SSC
Strip crown
Technique
Contd...
Esthetic
Time
consuming
Needs
moisture
control
Can be crimped
and trimmed
Open faced
crowns
Easy to place
Not technique
sensitive
Difficult to
crimp, and
trim
Difficult
to repair if
fractured
Expensive
Cannot be
trimmed or
crimped
Prefabricated
veneered SSC
ery good in
V
esthetic
Can not
trimmed or
crimped
Needs
more tooth
reduction
Not possible
Ceramic/
Zirconia crown
Economical
Easy to adapt
Temporary
crown
Strength no up
to mark
3M ESPE
Anterior and
posterior
Can be trimmed,
crimped,
contoured
Polycarbonate
crown
Economical
Easy to
perform
Patient
acceptance not
there
Availability
No study
to check
durability and
strength
Anterior
Crimping,
contouring not
possible,
trimming can be
done
Biologic crown
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146
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147
Form 2: Crown order form for iso-crown for (molar, bicuspid), Gold anodized (molar/bicuspid
crown), Polycarbonate crown, Strip crown.
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148
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149
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150
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151
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152
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Index
Page numbers followed by t refer to table and f refer to figure
A
Abrasion 27
Acrylic resin 51
Allergic reaction 5
Aluminum crown 70f
adaptation 71t
Anesthesia 38, 63
Art glass crown 95f, 96f
Aseptic technique 5
B
Biologic restoration procedure 123f
Bruxism 28, 87
C
Canine NuSmile crown 103f
Caries 26
extensive 62
Caulks adhesive 75
Cementoenamel juction 30
Ceramic blocks 119f
Ceramo basemetal crown 21
CEREC crown 21, 119, 121
CEREC one-visit crown placement procedure 119
Cheng crown 21, 99, 107
Clamp in rubber dam, bow of 15
Complete arch kit 107
Composite 88
insertion of 73
kit 9f
post 128, 128f, 130
resin 51
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154
grabber instrument 93
height of 38
high density polyethylene 110
inhalation of 62
ion 25
loose 5
marginal adaptation of 49
morphology 59
nickel-based 23, 31
nickel-chromium 25, 34
NuSmile 21, 99-101
over amalgam restoration 30
over extension of 62, 134
pediatric 2, 7, 103
pedo jacket 21, 85, 93
PedoNatural 21, 85, 90
placement 7, 80
procedure of 78, 104
technique of 89
polycarbonate 85, 85t
portion, fabrication of 122
posterior 108, 117
pretrimmed 32
resin 75
retention 49
scissors 9
selection 8, 35, 36, 78, 87, 112
and adaptation of 64
method of 37
sizes 60, 108
stainless steel 67
sterilization of 52
strip 21, 77
tilt 61, 133
tin-based 23, 34t
ZIRKIZ 21, 111
Curved scissor 10f
E
Early childhood caries 125f
G
Gingival contour 46
Gingival finish lines 6f
Gingival health 6
Glass fiber reinforced composite resin posts 128
Glass ionomer 51
cement 19, 29, 91, 126
crown 21, 84
H
Head tilt-chin lift technique 139f
Heimlich maneuver 136, 137f
High density polyethylene crown 21, 110
Howe pliers 9
Hybrid acrylic fill material 91
Hypoplastic defects 27
I
Incisors and molars 2f
Isolation procedure 10
J
Johnsons ball and socket contouring pliers 9
K
Kinder krown kit 118t
Kudos crown 21, 85, 88, 89f
L
Laryngoscopy 140f
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Index
Sensitivity 6
Silicophosphate cement 19
Split dam method 16f, 79
Stainless steel crown 2, 21, 23, 26, 31, 33t, 41f, 43f,
54, 74, 97
adjacent 54
classification of 31
for permanent teeth 66
placement, modifications of 53
restoration 51
traditional 112
Stainless steel refill box 37f
Straight crown cut scissor 10f
Strip crown 83f
order form 152f
placement procedure 81f
O
Omega-shaped post 127, 129
P
Pedo jacket crown 94f
Pedo pearls 21, 104, 107f
kit box 106f
Pedonatural crown placement 92f
Polishing 48, 73
Polycarbonate crown 21, 85, 86, 86f, 92f
Polycarboxylate cement 19
Polyethylene fiber post 128f
Post and core fabrications, modification in 130
Post space design, type of 126
Post, types of 126, 129f
Primary molar NuSmile crown 103f
Primary teeth, importance of 4, 5
Proximal ledge formation 133f
Pulp therapy 26
Punching sheet, method of 13f
T
Threaded post 129
Tooth
isolation, individual 15, 79
preparation 73, 80, 91, 112, 122
reduction of 39
restoration, fractured 28
Troutmans preparation 47
155
W
Wedging 39
Wipe excess cement 60
Z
Zinc oxide eugenol 17f, 51
cement 17, 18, 70
Zinc phosphate 17, 17f, 18, 20, 51
cement 18
Zinc polycorboxylate cement 17
Zinc silicophosphate 51
Zirconia pediatric crowns 112
ZIRKIZ crown 112f
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