Stainless Steel Crowns for Primary Teeth PDF

Summary

This is a presentation on stainless steel crowns for use in pediatric dentistry. It covers their advantages, disadvantages, types, preparation techniques, indications, and considerations. The presentation examines success rates, metal allergies, and gingival health.

Full Transcript

STAINLESS STEEL CROWNS PRESENTED BY RANDA YOUSSEF STAINLESS STEEL CROWNS  First used in the late 1940s and became commonly used in the 1960s  Gained popularity and acceptance along with the idea of “pediatric dentistry” Introduction It was introduced as chrome-steel...

STAINLESS STEEL CROWNS PRESENTED BY RANDA YOUSSEF STAINLESS STEEL CROWNS  First used in the late 1940s and became commonly used in the 1960s  Gained popularity and acceptance along with the idea of “pediatric dentistry” Introduction It was introduced as chrome-steel crowns Now it is commonly called as stainless steel crown. The stainless steel crown is used more frequently in deciduous dentition. Advantages of Stainless Steel Crowns  Can be used for badly broken down crowns  Can be placed with poor isolation  Fast  Economical  Full coverage-prevents recurrent decay  Durable TYPES Types 1. Untrimmed crowns: 2. Pretrimmed crown: straight, non contoured sides but are festooned to follow a line parallel to the gingival crest. 3. Precontoured crown : festooned and precontoured. COMPOSITION Composition Stainless Steel Crowns Nickel – base Crowns 17-19% chromium  Nickel – base Crowns 10-13% nickel 72% nickel 67% iron 14%chromium 4% minor 6-10% Iron element 0.04% carbon 0.35% manganese 0.2% silicon  Nickel – base Crowns The alloys have good formability and ductility necessary for clinical adaptation of crowns and wear resistance to resist opposing occlusal forces. Success of SSC Vs. Amalgam in Primary Molars  The success rate of SSCs vs. multi-surface amalgams goes up dramatically for restorations place in children under the age of 4 years. Reasons Given for Not Placing Stainless Steel Crowns  Time Consuming to Fit  Difficult to Manipulate  Expensive  Ugly!!!!!! DISADVANTAGES Disadvantage of SSC  Time Consuming  Difficult to Manipulate  Expensive  Ugly Stainless Steel Crowns are !!!Fast Most pediatric dentists can place one in 10 minutes or less-you can too!  Stainless Steel Crowns are just as easy to manipulate as a matrix band! ?What About Metal Allergy  SSCs contain nickel and chromium. It is the nickel which may elicit an allergic response in some patients.  Although more prevalent in females, intraoral allergic responses seem to be more minimal than extraoral responses and also ‘scarce.’ What About Gingival ?Health  “Plaque accumulation and frequency of gingival problems associated with SSCs in primary teeth seem to be unexceptional”  Some increased inflammation is seen in permanent dentitions after puberty. INDICATIONS :Indications 1. After pulpal therapy 2. Multi-surface carious lesions 3. Proximal box extended beyond ideal 4. Restoration of caries in high risk caries patients 5. Teeth with extensive attrition 6. Behavior changes 7. For teeth deformed by developmental defects or anomalies. 8. For teeth with hypoplastic defects. 9. As an abutment. 10. Temporary restoration of a fractured tooth. 11. Single tooth crossbite. SSC Indications Large, Deep Caries Caries on 3 or more surfaces SSC Indications Following Pulp Therapy SSC Indications Large, Deep Caries Enamel Hypoplasia 1st Permanent Molars PREPARATION Anatomical Differences Primary vs. Permanent A. Enamel Thickness B. Dentin Thickness C. Pulpal Size D. Gingival Bulge View of Buccal Cervical Bulge: This is what retains an SSC “Sweetspot” Remains SSC Technique Proper Crown Fit: There are no crown margins The SSC fits over the remaining crown and adapts with a crimped contour. SSC Technique Clinical Procedure  Evaluate the preoperative occlusion  Selection of crown The correct size crown is selected by the M-D dimensions of the tooth to be restored using Boley gauge. I. THE “SLOPPY BOX” TECHNIQUE II. THE “DEPTH GROOVE” TECHNIQUE Stainless Steel Crown Preparation I. THE “SLOPPY BOX” TECHNIQUE Stainless Steel Crown Preparation Cut an MOD Prep #330 Bur Reduce Occlusal 45 Degrees Lingual Cusp Reduction-Use Base of MOD Prep as Guide mm Buccal 1-1.5 Counterbevel Lingual Counterbevel Round Proximal Box From Line Angle to Line Angle Mesial Prep Complete/Distal Not Complete :Distal Open Occlusal Reduction: Adequate for Height of SSC ~1-1.5 mm II. THE “DEPTH GROOVE” TECHNIQUE Stainless Steel Crown Preparation Depth Groove” Technique“ Connecting Depth Grooves Placing Counterbevel Counterbevels Complete Slicing Proximals Prep Complete Initial adaptation of crown  Two principles related to SSC length and margin shape that are based on an understanding of the tooth morphology and gingival tissue contours.  The crown should be of a correct length and its margins should be adapted closely to the tooth.  For shaping the crown margins mark 3 light points on the metal at the (mesiolingual, lingual and distolingual)and at (mesiobuccal, buccal, distobuccal) surfaces at the crest of respective marginal gingiva without compressing the marginal gingiva.  Final finished margins are placed approximately 1mm below these marks. Seating the crown  Now the crown is tried on the preparation by seating the lingual first and applying pressure in a buccal direction so that the crown slides over the buccal surface into the gingival sulcus.  Resistance should be felt as the crown slips over the buccal bulge. Select SSC for Mesial-Distal Space: Usually Rocks on From Lingual to Buccal Should “Snap” into Place Over Cervical Bulge Check for Open Margins Remove With Sturdy Instrument Crown contouring  Initial crown contouring is performed with a 114 plier in the middle 1/3rd of the crown to produce a belling effect.  This will give the crown a more even curvature. Crown crimping  The tight marginal fit aids in: 1. Mechanical retention of the crown. 2. Maintenance of gingival health. 3. Protect of cement from exposure to oral fluids. Crimping To Adapt Margins Band Contouring Plier Note: Adapted Margins Uncrimped vs. Crimped CROWN CONTOURING Crown crimping Checking the final adaptation of the crown  The crown should be replaced on the preparation after the contouring procedure to see that it snaps securely into place.  The occlusion should be checked at this stage to make sure that the crown is not opening the bite or causing a shifting of mandible into an undesirable relationship with opposing teeth. Patient Bites Into Occlusion Confirm Occlsion Finishing and polishing  Accumulation of plaque and inflammation of gingiva is commonly seen in practice of restorative dentistry due to rough and unpolished restoration.  To avoid these complications crown should be polished prior t o cementation with rubber wheel to remove all scratches. Radiographic confirmation of the gingival fit  Before cementation a bitewing is taken to verify proximal marginal integrity Cementation  SSC should be cemented only on clean dry mouth, isolation of teeth with cotton roll is recommended.  Rinse and dry the crown inside & out side and prepare to cement it.  A zinc phosphate, polycarboxylate or GIC is preferred.  Before the cements set ask the patient to close into centric occlusion by applying pressure through a cotton roll and confirm that the occlusion has not been altered.  Remove the excess cement by an explorer or scaler & for interproximal area can be cleaned by passing dental floss through them. Result SPECIAL CONSIDERATION special consideration for ssc  Quadrant dentistry -Prepare the occlusal reduction of one tooth completely before beginning the other ……… -Reduce the adjacent proximal surface of the teeth being restored more than when only one tooth is restored…….. -Both crown should be trimmed, contoured and prepared before cementation simultaneously to allow for adjustment in inter proximal space and establish proper contact area. Crown in area of space loss ………………………………………. Preparing a SSC adjacent to a class II amalgam ……………………………………………….. Undersize tooth or the oversize crown. Undersize tooth or the oversize crown. …………………………………………… Oversize tooth or undersize crown ……………………………………. Deep subgingival.caries …………………...Open contact ………………………….Crown tilt ………………… Poor margins ……………………….. Complications  Inhalation or ingestion of crown.  QU ES TIO NS AR E WE LC OM

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