Restorative procedures for the child 3: stainless steel crowns

Question 1

What are the benefits of pre-formed crowns?

Answer 1

• single visit procedure
• far superior than other restorations (strength, longevity, cost-effective). Last longer than any other restorative material in children.
• predictable, have been used for over 50 years
• no impressions needed
• no lab work needed

Question 2

What are the indications for using pre-formed crowns?

Answer 2

• 1st molars require multi-surface restorations
• used in children with rampant caries
• used after pulp therapy
• used in children with developmental defects
• used in worn/fractured teeth
• to maintain space
• used in children who experience bruxism

Question 3

What are the absolute and moderate contraindications of using pre-formed crowns?

Answer 3

absolute:

• Caries through the floor of the pulp chamber
• Primary molar is soon to exfoliate
• Unsuccessfully pulp-treated tooth

moderate:

• Poorly motivated patient / parent
• Poorly cooperative patient
• Multiple grossly carious teeth

Question 4

What materials can crowns be made from?

Answer 4

• stainless steel (most expensive)
• nickel chromium steel
• aluminium (cheapest)

Question 5

What shapes can crowns come in?

Answer 5

pre-crimped/un-crimped

pre-contoured/ un-contoured

Question 6

What equipment is needed for crowns?

Answer 6

• set of preformed crowns
• burs
• crown scissors
• crimping pliers
• calipers
• crown remover
• floss
• suction

Question 7

What cements can be used to place crowns?

Include brand names

Answer 7

• glass ionomer luting cement (AquaCem)
• Zinc oxide eugenol cement (Kalzinol)
• Polycarboxylate cement (Poly F)

Question 8

What is the pre-procedure for placing a stainless steel crown?

Answer 8

• remove caries
• ensure tooth is restorable
• carry out pulpotomy if necessary
• for 2 visit: place temporary restoration and arrange next appointment.
• for 1 visit: carry out entire procedure

Question 9

What are the 3 stages in crown placement?

Answer 9

1- preparation
2- adaptation
3-cementation

Question 10

What is involved in the preparation stage of crown placement?

Answer 10

1- LA given and isolate tooth (rubber dam, cotton wool)
2-reduce mesial and distal proximal surfaces
3-remove bulbosities/irregularities as necessary
4-round off sharp edges
5- select a crown and try it on tooth
(Lower: lingual to buccal)
(upper: buccal to palatal)

Question 11

What is involved in the adaptation stage of crown placement?

Answer 11

after selecting a crown and trying it on the tooth it may need to be adjusted.

• contour: tooth shape
• trim: gingival margin
• crimp crown: at marginal edge

Question 12

What is involved in the cementation stage of crown placement?

Answer 12

1- dry tooth thoroughly
2-mix cement to ‘clotted cream’ consistency
3-load cement into crown
4-seat firmly
5-remove excess cement with probe and floss
6-check completed restoration

Question 13

What is the Hall technique?

Answer 13

it is a form of minimally invasive dentisry.

It quick and cost-effective.

Question 14

What are the stages in Hall technique crown placement?

Answer 14

1- no LA is required
2-isolate tooth (rubber dam, cotton wool)
3-no caries removal or preparation
4-size up crown (don’t fully place on tooth!)
5- mix GIC cement and fill crown
6-sit patient upright
7-place crown on tooth and get patient to bite down on cotton wool
8-remove excess cement
9-review in 2-3 weeks