Full Coverage in Pediatric Dentistry PDF

Dr. Rabab Full coverage Mahmoud Abd in Pediatric Elhakam Dentistry Researcher at the National Research Centre Orthodontics and Pediatric Dentistry Department Lecture...

Dr. Rabab Full coverage Mahmoud Abd in Pediatric Elhakam Dentistry Researcher at the National Research Centre Orthodontics and Pediatric Dentistry Department Lecturer at Ahram Canadian University Member of the Egyptian Society for Pediatric Dentistry and Children with Special Needs (ESPSN) Member of Center for Oral Dental and Health Promotion (CODE HP) Two ways to classifying crowns to restore primary teeth Based on its method of cementation, it is classified into: 1. Cemented crowns 2. Bonded crowns Based on its material, it may be classified into: a) Stainless steel crowns b) Preveneered stainless steel crowns c) Polymer crowns d) Composite crowns e) Zirconia crowns  Crowns Classification Cemented Crowns : Stainless steel crowns Cheng crowns Dura crowns Kinder Krowns Pedo pearls NuSmile crown Whiter Biter crowns Pedo Compu crowns Pedo Compu crowns EZ Pedo crowns  Crowns classification Bonded Crowns: Polycarbonate crowns Strip crowns Pedo jacket New millennium crowns  Pre-Formed Metal Crowns (PMC)=SCC It was first described by Rocky mountain company 1947 and popularized by Dr. William Humphrey in 1950 The metal used in preformed crown was soon transformed to nickel-chromium. It is semi-permanent restoration used for primary and permanent teeth  Indications After pulp therapy in primary molars. restoration for an extensively decayed primary tooth. In children requiring general anesthesia. Severe bruxism. Hall technique. Rampant and recurrent caries. A semi-permanent restoration for treating severe enamel defects or grossly carious permanent molars As part of a space maintainer Hall technique The Hall technique (HT), developed in the United Kingdom, offers a simplified technique for the SSC procedure without the use of local anesthesia, tooth preparation, or caries excavation  Molar-Incisor Hypomineralization After pulp therapy in Primary molars  Crowns verse multi-surface restorations There is evidence from retrospective studies showing greater longevity of preformed metal crowns compared to amalgam or resin-based restorations for the treatment of caries lesions in primary teeth Therefore, use of S S C s is supported on high-risk children with large or multi- surface cavitated lesions on primary molars, especially when children require advanced behavioral guidance techniques including general anesthesia for the provision of restorative dental care  Contraindicat ions 1. Esthetic problem 2. Molars near exfoliation 3. The dental caries reach the roots 4. Beyond possible repair molars  Advanta ges Durable It protects the remaining tooth structure which was weakened by excessive caries removal Less technique sensitive Cost effective Low failure rate  Disadvanta ges Unesthetic due to metallic appearance cannot be used in partially erupted tooth  Note - Some parents/guardians find the appearance of the SSC to be unacceptable, so an SSC should be shown when informed consent is being obtained - With uncooperative behavior, an SSC is preferable to an esthetic crown, as an esthetic crown requires extensive tooth reduction and longer chair time Types of stainless steel crowns based on morphology 1. Untrimmed Crowns 2. Pretrimmed Crowns 3. Precontoured Crowns  Types of stainless steel crowns Untrimmed Crowns: Neither trimmed nor contoured It is time-consuming and requires a lot of time for adaptation Ex: Rocky mountain Pretrimmed Crowns: Have straight, non-contoured sides These are designed to follow a line parallel to the gingival crest They still need some trimming and contouring Pre-contoured Crowns: are festooned and pre-contoured (minimal amount of festooning and trimming may be required) Types of stainless steel crowns  Techniq ue 1-local anaesthesia should be used because of the soft-tissue Manipulation 2- Reduce the occlusal surface by about 1.5 mm using a flame- shaped or tapered diamond bur. Uniform occlusal reduction will facilitate placement of the crown without interfering with the occlusion 3- Using a fine, long, tapered diamond bur, held slightly convergent to the long-axis of the tooth, and cut interproximal slices mesially and distally. The reduction should allow a probe to be passed through the contact area 4- Little buccolingual reduction is needed unless there is a prominent Carabelli’s cusp etc. However, such reduction should be kept to a minimum as these surfaces are important for retention  Techniq ue 6- An appropriate size crown is chosen by measuring the mesiodistal width 7- A trial fit is carried out before cementation. It is important that the crown should sit no more than 1 mm sub gingivally 8- If there is excessive blanching of the gingival tissues the length of the crown should be reduced (Crown occlusogingival dimension is wrong). The margins should be smoothed with a white stone Gingival blenching ( the colour of the gingia around the SSC turns white ) indicate that the margins need trimming  Cementat ion Glass ionomer cement  Open-Faced Stainless Steel Crowns (cemented crown) Ssc are the most reliable and durable restoration for a primary incisor but have poor aesthetics. To take advantage of its strength and to make it attractive, the buccal aspect of the crown should be cut away by the dentist and filled with bonded composite. Open-Faced Stainless Steel Crowns Open Face Stainless Steel Crown Advantages: More esthetic than ssc Disadvantages: Time-consuming procedure Metal margins can still be seen Lifespan is short Poor color stability under oral conditions  Pre-veneered Stainless Steel Crown (cemented crown) Have the combined effect of the durability of SSC and the esthetics of composite resin These were developed for primary anterior only but later were also designed for primary molars Different types of PVSSCs available depend on attachment to the SSC Advantages:  Good esthetics with relatively short operating time  Durability is long  It can be used with ease where moisture condition is difficult Pre-veneered Stainless Steel Crown Disadvantages:  have more thickness than conventional SSC due to the addition of resin = more extensive tooth preparation for proper fit and occlusion.  It is more expensive ( compare to ssc ).  Dentists don’t have many options on resin shade.  have overly convex appearance so reshaping is required, =additional clinical time.  Multiple approximating crowns are difficult to place in people with loss of space due to bulk or crowding.  Inflexibility and brittleness seen on resin  Not e Informed consent should include : possible chipping or loss of facings to longer time required for the procedure possible addition of a pulpotomy treatment plan.  Zirconia Pediatric Crown These are crowns made of zirconia (metal free). Zirconia has demonstrated superior corrosion- resistant, high wear resistance, and excellent biocompatibility. Commercially available pediatric zirconia crowns are: 1. E Z Pedo Crowns. 2. NuSmile Zirconia Crown. 3. Cheng Zirconia pediatric crowns. 4. Kinder Zirconia crowns.  Nusmile Crowns These were introduced in the year 1991 Used when a full-coverage restoration is required for longevity and to protect the remaining tooth structure. They are available in 2 forms: Nusmile Signature and Nusmile ZR Rememb er The NuSmile Signature crowns are anatomically correct with a natural tooth-colored coating which is an alternative to the traditional stainless steel and composite strip crowns. NuSmile ZR: is made from zirconia ceramic which offers superior esthetic. Its durability is compared to(similar to)the NuSmile Signature.  Zirconia Pediatric Crown Indications: 1. Discolored primary incisors 2. Multisurface or extensive caries in deciduous incisors 3. Fractured incisors following trauma 4.Developmental defects like amelogenesis imperfecta Contra Indications: 5. Not adequate if excavation of caries results in less remaining tooth surface area 5. Not indicated in deep bite 6. in the presence of periodontal disease  (cemented crown) : These are anatomically similar to natural teeth. Compatible to tooth colors Color stability Can be easily placed Less time consuming than open faced ssc Less technique sensitive than open faced ssc. Durable. High strength and toughness Can withstand wear and tear Biocompatible  Disadvantages of zirconia Abrasive effect on tooth High cost Longer chair side time than ssc more tooth reduction than ssc and strip crowns.  Technique of zirconia crown preparation 1-Give profound anesthesia. 2-Use a football or coarse tapered diamond stone to reduce the occlusal surface of the tooth by 2mm. 3- Carefully prepare the tooth bucally ,ligually, mesially and distally from 1- 1.25mm. The reduction will extend subgingivally by thin tapered stone creating feather –edge margine 1-  Technique of zirconia crown preparation 4- rounded line angles. 5-for Nusmile crowns: use the pink try in crowns to choose the right size 6- check occlusion. 7- isolate the tooth , ensure hemorrhage and saliva isolation ,cement the zirconia crown using reinforced chemical cure glass ionomer= resin modified glass ionomer= (EX: Riva capsules ) Technique of Preparation  Composite resin strip crowns (bonded crown) Composite is the material of choice for the restoration of primary anterior teeth. An anterior strip crowns with composite resin provides an aesthetic and durable restoration.  Composite resin strip crowns Advantages : Quick ,simple Cheaper than zirconia crowns Single visit Disadvantages : cannot be sterilized Not as strong as zirconia crowns.  Methods  Local anaesthesia  rubber-dam isolation should be used if possible. Alternatively, because of age and poor cooperation of younger children.  Select the correct celluloid crown form depending on the mesiodistal width of the teeth.  Remove the caries using a slow-speed round bur.  Using a high-speed tapered diamond carbide bur, reduce the incisal height by around 2 mm, prepare interproximal slices and place a labial groove at the level of  rim the crown form and make two holes in the incisal corners by piercing with a sharp explorer.  Etch the enamel for 30 seconds, and wash and dry.  Apply a thin layer of bonding resin and cure for 20 seconds, ensuring all surfaces are covered equally.  Fill the crown form with the appropriate shade of composite and seat with gentle, even pressure, allowing the excess to exit freely. The use of small wedges may be helpful in avoiding interproximal excess.  Light cure each aspect (labially, incisally and palatally) equally.  Remove the celluloid crown gently, and adjust the form and finish with either composite finishing burs or abrasive discs.  The Pedo Jacket crown (bonded crown) It is made of a copolyester material in the natural primary tooth color shade A2. It will be bonded withresin and left on the tooth instead of removing it like a strip crown after polymerization. It is flexible and its length can be trimmed with scissors (not with high speed bur) This is the only flexible or soft crown option compared to the other crowns Polishing is not required. Disadvantages : Only a single size and shade is available, so shade matching with adjacent tooth will be a potential problem. Wear in areas of heavy occlusion Polycarbonate Crowns (bonded crown)  Polycarbonate Crowns are another type of preformed full- coverage crowns which are made of heat-molded acrylic resin. Bonded using resin cement. Polycarbonate Crowns Include: 3M ESPE Polycarbonate Kudos polycarbonate crowns PedoNatural Crowns.  Polycarbonate Crowns INDICATIONS 1. Full coverage restorations of maxillary anterior teeth extensively involved with caries ( Children exhibiting nursing bottle caries) 2.Malformed or fractured teeth 3.Discolored teeth 4.After pulpectomy or pulpotomy procedures CONTRAINDICATIONS 5.Bruxism 6.Evidence of excessive abrasion to anterior teeth Polycarbonate Crowns ADVANTAGES 1. Improved esthetics 2. Extreme dimensional stability 3. Less chair side Time DISADVANTAGES 4. Poor abrasion resistance 5. Poor retention form :Crown is frequently dislodged if the tooth is heavily destroyed  Cheng Crowns (cemented crown) These were developed by Peter Cheng in the year 1982. Available in two form : 1. Cheng Crowns classic: metal- reinforced sub-strucure crowns with a facing of pure resin which makes them stain resistant. Cemented by: Glass ionomer cement. 2. Cheng zirconia crowns: zircona crowns cemented by resin modified glass ionomer. These can be used for both anterior and posterior teeth. Advantages 1. Less time consuming 2. Less technique sensitive 3. Require a single patient visit. 4. Less patient discomfort. 5. Stain resistant.  Kinder Crowns (cemented crown) introduced in 1989 providing shades that appear natural and good contour for the patient. known for their finely feathered margins, The finely feathered margins help create an esthetic emergence profile. Available as 1. zirconia Kinder crowns 2. preveneered Kinder crown available for anterior or posterior teeth. Dura Crowns: (cemented crown) Dura crowns are of a high- made polyethyleneveneer density ed crown These crowns can be crimped labially, lingually, and can be trimmed with crown scissors and festooned. It also has a full knife edge  Dura Crowns These preveneered crowns are esthetic and can be placed with poor moisture or hemorrhage control. Advantages: Facial and lingual surfaces may be crimped. Easily festooned Easily trimmed Full knife-edged margin capabilities.  NEW MILLENIUM CROWNS (bonded crown) Made of a laboratory enhanced composite resin material (filled with resin and bonded to the tooth) very esthetic and can be finished and reshaped very brittle; can crack or fracture if forced down onto a preparation that has not been adequately reduced Expensive. ADVANTAGES 1. Highly esthetic 2. High Parental satisfaction DISADVANTAGES 1. Most technique sensitive. 2. Proper isolation and hemostasis are crucial for successful treatment. 3. Ideal oral hygiene prior to commencement of treatment is preferred but is not always  NEW MILLENIUM CROWNS INDICATIONS 1.Extensive or multisurface caries in primary incisors 2.Congenitally malformed primary incisors 3.Discolored primary incisors 4.Fractured primary incisors following trauma 5.Developmental defects like Amelogenesis imperfecta CONTRAINDICATIONS 6.If caries removal results in insufficient tooth surface area for bonding or extensive subgingival caries. 2.If moisture control is difficult. 3.Deep overbite 4.The presence of periodontal disease.  Pedopearls o These are aluminum crown forms having a coating of a tooth-colored epoxy paint. o relatively softer( Aluminum is used because it bonds more effectively to epoxy paint but they are relatively softer and may cause the epoxy paint to wear off in areas of heavy occlusion). o can be easily crimped and cut but durability is poor.  Figaro crowns (cemented crown) The Figaro Preformed crown is made of layers fiberglass held together by epoxy resin. Small amounts of Titanium Dioxide and Yellow Iron oxide are added for cosmetic affect.  Biocompatible.  Strong  Safe =do not allow for sharp edges due to tooth grinding or shattering of the crown while clenching or chewing  Cost Effective  Metal Free  Autoclavable  Please remember NO FINISH LINE FOR ANY PREPATION OF ANY PEDIATRIC CROWN