Stainless Steel Crowns
STAINLESS STEEL CROWNSFirst 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 LiteratureThe Use of Stainless Steel Crowns
Seale, NS; Pediatric Dent. 2002 Sept-Oct;24 (5):501-5
Advantages of Stainless Steel CrownsCan be used for badly broken down crownsCan be placed with poor isolationFastEconomicalFull coverage-prevents recurrent decayDurable
Success of SSC Vs. Amalgam in Primary MolarsCombined 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 DentistryLongevity 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 Crowns35.5% Amalgam25.8% Glass Ionomer29.1% 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 StudyGeneral 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=9371% 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 CrownsTime Consuming to FitDifficult to ManipulateExpensive
Reasons Given for Not Placing Stainless Steel CrownsTime Consuming to FitDifficult to ManipulateExpensive
Ugly!!!!!!
Disadvantage of SSCTime ConsumingDifficult to ManipulateExpensive
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 EconomicalYou decide the feeBest 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 unexceptionalSome increased inflammation is seen in permanent dentitions after puberty.Fayle. Int J Paediatr Dent. 1999
Stainless Steel Crowns (SSC)
Indications: Primary TeethAfter pulpal therapy
SSC IndicationsFollowing Pulp Therapy
Indications: Primary TeethAfter pulpal therapyMulti-surface carious lesions
SSC IndicationsLarge, Deep CariesCaries on 3 or more surfaces
Indications: Primary TeethAfter pulpal therapyMulti-surface carious lesionsProximal box extended beyond ideal
SSC IndicationsLarge, Deep CariesCaries on 3 or more surfaces
Indications: Primary TeethAfter pulpal therapyMulti-surface carious lesionsProximal box extended beyond idealRestoration of caries in high risk caries patients
Indications: Primary TeethAfter pulpal therapyMulti-surface carious lesionsProximal box extended beyond idealRestoration of caries in high risk caries patientsTeeth with extensive attrition
Indications: Primary TeethAfter pulpal therapyMulti-surface carious lesionsProximal box extended beyond idealRestoration of caries in high risk caries patientsTeeth with extensive attritionBehavioral Challenges
Indications: Permanent TeethInterim restoration until a more permanent restoration can be doneFinancial barriers prevent gold or PFM crownExtensive developmental defects. Restore occlusion and reduce sensitivity due to enamel and dentin dysplasia.
Large, Deep CariesEnamel Hypoplasia1st Permanent MolarsSSC 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 SSCsWhite facing prone to fracture and lossTooth must be reduced significantly more than conventional SSC prep- therefore, pulp exposure more likelyCannot crimp or trim as much as conventional SSC
Stainless Steel Crown Technique
Anatomical DifferencesPrimary vs. Permanent Enamel Thickness Dentin Thickness Pulpal Size 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 BrokenLedges prevent SSC from telescoping over the tooth
Rubber Dam Slit Technique
The Sloppy Box TechniqueStainless 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