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