Stainless Steel Crowns

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”

Pediatric Dental Literature

The Use of Stainless Steel Crowns

Seale, NS; Pediatric Dent. 2002 Sept-Oct;24 (5):501-5

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

Success of SSC Vs. Amalgam in Primary Molars Combined raw data from 4 separate

studies show the failure rate for multisurface amalgams is 26% vs. 7% for SSCs after 5 years.

The success rate of SSCs vs. multi-surface amalgams goes up dramatically for restorations place in children under the age of 4 years.

Randall. Pediatric Dentistry-24:5, 2002

Evidence For General Dentistry

Longevity of Occlusally-Stressed Restorations in Posterior Primary Teeth

Hickel,R et al: Am J Dent 2005 Jun;18(3):198-211

Hickel Article

Reviewed Literature 1971-July 2003

Clinical performance of restorative materials in primary teeth.

Observed for a minimum of 2 years

Hickel Findings (failure rates)

14% Stainless Steel Crowns 35.5% Amalgam 25.8% Glass Ionomer 29.1% ART (Atraumatic Rest. Tx)

*SSC failures usually failure of overall tx i.e. tooth required extraction.

Attitudes of General Dentists

General Dental Practitioners’ Views On the Use of Stainless Steel Crowns to Restore Primary Molars

Threlfall AG et al: Br Dent J 2005 Oct 8; 199(7):453-5.

Threlfall Study

General DDS treatment planned clinical care for primary dentitions

Case was of a child that should have stainless steel crowns according to the guidelines of the British Society of Paediatric Dentistry.

Threlfall Study N=93 71% of the general dentists knew

the BSPD guidelines for placement of SSCs.

Only 7% of general dentists said they would place a SSC in this case

Only 18% had ever used an SSC in their practice.

Reasons Given for Not Placing Stainless Steel Crowns

Time Consuming to Fit Difficult to Manipulate Expensive

Reasons Given for Not Placing Stainless Steel Crowns

Time Consuming to Fit Difficult to Manipulate Expensive

Ugly!!!!!!

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!

Stainless Steel Crowns are Economical

You decide the fee Best chance of one appointment

treatment.

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.’

Janson et al. Am J Orthod Dentofacial Orthop. 1998

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.

Fayle. Int J Paediatr Dent. 1999

Stainless Steel Crowns (SSC)

Indications: Primary Teeth

After pulpal therapy

SSC Indications

Following Pulp Therapy

Indications: Primary Teeth

After pulpal therapy Multi-surface carious lesions

SSC Indications

Large, Deep Caries Caries on 3 or more surfaces

Indications: Primary Teeth

After pulpal therapy Multi-surface carious lesions Proximal box extended beyond

ideal

SSC Indications

Large, Deep Caries Caries on 3 or more surfaces

Indications: Primary Teeth

After pulpal therapy Multi-surface carious lesions Proximal box extended beyond

ideal Restoration of caries in high risk

caries patients

Indications: Primary Teeth

After pulpal therapy Multi-surface carious lesions Proximal box extended beyond

ideal Restoration of caries in high risk

caries patients Teeth with extensive attrition

Indications: Primary Teeth

After pulpal therapy Multi-surface carious lesions Proximal box extended beyond ideal Restoration of caries in high risk

caries patients Teeth with extensive attrition Behavioral Challenges

Indications: Permanent Teeth

Interim restoration until a more permanent restoration can be done

Financial barriers prevent gold or PFM crown

Extensive developmental defects. Restore occlusion and reduce sensitivity due to enamel and dentin dysplasia.

Large, Deep Caries Enamel Hypoplasia

1st Permanent Molars

SSC Indications

AAPD (Amer Assoc Pediatric Dentists)Consensus on Use of SSCs

Children at high risk exhibiting anterior tooth decay and/or molar caries may be treated with SSCs to protect remaining at-risk surfaces.

Extensive decay, large lesions or multiple surface lesions in primary molars should be treated with SSCs.

Strong consideration for use of SSCs in children who require GA

Problems with “White” SSCs

White facing prone to fracture and loss

Tooth must be reduced significantly more than conventional SSC prep- therefore, pulp exposure more likely

Cannot crimp or trim as much as conventional SSC

Stainless Steel Crown Technique

Anatomical Differences

Primary vs. Permanent

A. Enamel ThicknessB. Dentin ThicknessC. Pulpal SizeD. Gingival Bulge

View of Buccal Cervical Bulge: This is what retains an SSC

BUCCAL CERVICAL “SWEETSPOT”: THIS IS THE CRITICAL AREA FOR RETENTION

Prep (L) vs. No Prep (R): “Sweetspot” Remains

Proper Crown Fit: There are no crown marginsThe SSC fits over the remaining crown and adapts with a crimped contour.

SSC Technique

Proximal Contacts Must be Well Broken

Ledges prevent SSC from telescoping over the tooth

Rubber Dam “Slit Technique”

The “Sloppy Box” Technique

Stainless Steel Crown Preparation

Cut an MOD Prep #330 Bur

Reduce Occlusal 45 Degrees 1/8 A Diamond Bur

Lingual Cusp Reduction-Use Base of MOD Prep as Guide

1-1.5 mm Buccal Counterbevel

Lingual Counterbevel

Round Proximal Box From Line Angle to Line Angle

Mesial Prep Complete/Distal Not Complete

Note: No Gingival Seat Ledge Remains on Mesial!

Distal Prepped: No Ledges

SSC Technique

Note: Rounded Line Angles

Occlusal Reduction: Adequate for Height of SSC ~1-1.5 mm

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

Crimping To Adapt Margins

Band Contouring Plier

Note: Adapted Margins

Uncrimped vs. Crimped

Patient Bites Into Occlusion

Confirm Occlsion

“Depth Groove” Technique

Depth Groove Technique #K

Cut Occlusal Guides #330 Bur

Occlusal Depth Grooves

Connect Depth Grooves

Connecting Depth Grooves

Placing Counterbevel

Counterbevels Complete

Slicing Proximals

Prep Complete

Finishing Steps The Same