STAINLESS STEEL CROWNS

TYPES INDICATIONS APPLICATIONS

INTRODUCTION
Introduced by Humphrey 1950 Preformed extracoronal restorations Preformed metal crowns (PMCs) Excellent anatomic features Strong/ durable last 5 to 10 years Cost-effective- can be repaired Preventive quality Commonly used types -Pretrimmed (Denovo crowns) -Precontoured (Ni-Chro Ion crowns) -Preveneered SSCs (NuSmile crowns)

TYPES OF SSC

Chrome steel crowns Cro/Ni (18-8 alloy) 0.8-20% carbon.

High cro=less corrosion Work-harden= increase strength with manipulation Flux soldering=increase corrosion resistance Strength not affected by heating

Ni chrome crowns Commonly used type Chromium 17-20% Fe 65-73% Nickel 8-13% Mn/Si/C <2% Prefestooned Precontoured Minimum adaptability

Preveneered SSCs
Modification

of conventional SSC Prefabricated resin veneer facings Suitable for use on incisors Improved aesthetics

INDICATIONS

Extensive caries 10/ young 20 teeth Hypoplastic teeth (CEH) Following pulp therapy in 10 teeth Restore teeth with hereditary anomalies (DI/AI) Restore teeth in CSN/care where OH is poor and failure of other materials likely Abutment for space maintainer/prosthetic appliance To restore a fractured tooth Loss of two or three cusps Attachment for a habit-breaking appliance Protective- Severe attrition in primary/Bruxism Semi-permanent restoration in young permanent

CONTRAINDICATIONS
Aesthetics Tooth near time of exfoliation Mechanical problems space loss caries beneath the level of bone Permanent restoration in 20 teeth

ARMAMENTARIUM

Burs/stones: No.169L/69L Tapered diamond bur Green stone/heatless stone Wire wheel

Pliers: No.114 Johnson No. 137-Gordons No. 800-417 crown pliers Ball and socket pliers (optional)

 Sharp

scaler Crown and bridge scissors Cement medium: glass slab Spatula Zinc PO4 /polycarboxylate cement Polishing wheels Dental floss Rubber dam armamentarium

STAGES IN CLINICAL PROCEDURE

Tooth

preparation Crown selection Crown adaptation Placement of crown

Tooth preparation
Evaluate

preoperative occlusion LA/rubber dam Occlusal reduction No. 169 taper fissure bur high speed 1.0-1.5mm reduction. Maintain occlusal inclines. Treatment of carious lesion -A/F, pulp therapy

Proximal reduction
Taper fissure/thin tapered diamond bur. Break contact with adjacent tooth. Maintain vertical walls. Slight occlusal convergence. DO NOT OVER TAPER Feather finish line at gingival margin. Round off all line angles

Buccal/lingual reduction
Minimal

reduction about 0.5mm. Depends on bulbousity of crown Outline of the tooth should be apparent Contour to conform to the internal contour of the SSC Tooth prep influences the retentive property of the SSC.

NOTE
Proximal

slice must extend below tissue to avoid leaving a ledge Bevel at an angle of 30-450 to remove sharp cusp tips and for a gentle slope in the occlusal third of the lingual and buccal surfaces

Crown selection
Trial

and error process Start with smallest size adequate mesiodistal diameter. Proper occlusal height Crown should be somewhat larger than the tooth Crown should snap on tooth easily.

CROWN ADAPTATION
Remove rubber dam Select crown (size 4/5) with forceps. Place from lingual side. Rotate to buccal Crown fits loosely with 2-3mm excess gingivally Mark=scratch with a scaler the gingival line /margin With C&B scissors, cut 1mm below the scratch line Retry/rescribe/retrim

CONTOURING
Contour

crown with pliers. Use No.114 pliers to recontour gingival third Margins should be trimmed to lie parallel with the gingival contour. No sharp angles. Series of curves.

GUIDELINES

Resistance in seating without tissue blanching

high spots on occlusal surface ledges

Resistance in seating with tissue blanching.

crown too wide (preliminary contouring) crown too long tissue caught in margin

Finishing SSC prep

Contour gingival third to reproduce anatomic features Check margins with crimpling pliers or 110(Howe pliers) Replace SSC on tooth. Check margins with explorer. 800-417

FINISHING AND POLISHING

Smooth jagged edges with heatless stone Use a rubber wheel to remove small scratches and smoothen. Polish surface of crown to a high shine with tripoli and rouge

CEMENTATION
Clean Fill

crown and tooth

crown with zinc phosphate cement

Seat

crown, expressing cement form all margins and press into occlusion
set

Remove

excess cement when partially

POST-OP
Instructions: dislodge???...... Follow up home care Recall visit

Clinical Modifications
Adjacent SSCs Adjacent SSCs with loss of arch length SSC size Crown extension for deep proximal lesions

Causes of failure
Poor tooth prep Poor crown adaptation/retention Improper cementation methods Failure of pulp therapy Recurrent caries (interproximal) Crown abrasion occlusally

PRINCIPLES FOR SUCCESS WITH SSC

Caries

removal/pulp tx Optimum reduction of tooth Lack of damage to adjacent tooth Selection of appropriate crown Accurate marginal adaptation Good functional occlusion Optimum cementation procedure