Stainless Steel Crowns and Anterior Restorations

Question 1

What is the crown morphology of a priamry tooth?

Answer 1

• cervical bulge with gingival constriction
• narrow occlusal table
• broad contact areas located gingivally

Question 2

What are the indications for primary restorations?

Answer 2

• minimal restoration placed with relative ease when the lesion has just penetrated the dentine and cavitated can avoid the need for a larger restoration or even extraction later on
• in this way, operative procedures can be kept simple and used with preventive care to establish a positive experience and life long oral health

Question 3

Why are primary teeth restored?

Answer 3

• prevent pain, irreversible pulpitis and infection
• avoid extraction esp in medically compromised and anxiety cases
• preserve function
• maintenance of arch
• space maintenance for permanent successors
• anterior aesthetics

Question 4

What are the 2 main factors in choosing a restorative material?

Answer 4

1. Those relating to the tooth
   - extent of caries
   - cavity shape after caries removal
2. Factors relating to the patient
   - efficacy of isolation and moisture control
   - caries rate - stabilise with temp dressing to obtain control
   - aesthetic expectations

If the restoration is large, or a proximal lesion (class II cavity), place a preformed metal crown - this will strengthen the compromised remains

Question 5

What is a pulpotomy?

Answer 5

The procedure of removing the coronal part of the pulp tissue, inflamed or infected as a result of deep caries and the maintenance of vital radicular pulp tissue.

Question 6

Which treaty is relevant to paediatric dentistry?

Answer 6

Minamata treaty - no amalgam in deciduous teeth from 1st July 2018 due to environmental mecury pollution

Question 7

Give some facts about stainless steel crowns:

Answer 7

• considered the definitive restoration for Class II cavities in primary molars
• primary tooth morphology holds key to the retention of the stainless steel crown, it is held by cervical constriction
• now seen as the optimum restoration in primary molars for strength, durability and wear characteristics

Question 8

What are some indications for a stainless steel crown?

Answer 8

• class II cavities
• badly broken down teeth
• follwoing a pulpotomy
• hard tissue anomaly (amelo imperfecta)

Question 9

How do you select the appropriate crown?

Answer 9

• marked with size and position - always place writing to buccal aspect
• measure mesiodistal width of crown in the mouth to get a rough size

Question 10

Describe the conventional technique and prep of a stainless steel crown:

Answer 10

• remove caries
• prep tooth - occlusal and approximal (sliced prep)
• select crown and try into mesial and distal areas - do not seat fully, make sure there are no shoulders to prevent correct seating of crown
• cement crown
• remove excess cement
• check occlusion - will be high initially

Question 11

What is the Hall Technique for a stainless steel crown?

Answer 11

A method of managing carious primary molars using preformed metal crowns but without any preparation, caries removal or the use of LA

Question 12

Describe the technique of a Hall crown:

Answer 12

• child sits upright in dental chair
• find correct size of PMC
• fill crown with GIC (AquaCem)
• ask child to bite crown into place and encourage them to do so boldly and with commitment
• quickly wipe away excess cement

Question 13

What is rampant caries?

Answer 13

• widespread rapid growing caries on more than 1/3rd of teeth
• e.g. smooth surface caries on front 6 teeth - often associated with bottle mouth caries in preschool children

Question 14

What are some solutions to anterior caries?

Answer 14

• GI cement can be used in very young children to buy time although aesthetically poor
• composite resin can be used in the more cooperative case
• discing technique can be used in approximal anterior caries to create a self-cleansing cavity but preventive measures must be adhered to

Question 15

What are some good practices of LA in paediatric patients?

Answer 15

• always use adequate topical anaesthesia for infiltration but do not over use, or overload area
• LIA can be used for all work on deciduous teeth excluding lower D’s and E’s unless extraction (can be done with LIA)
• IDBs must be used for all procedures on lower second deciduous molars
• short needle can be used for children younger than 7 years

Question 16

What is the dose limitation for LA in children?

Answer 16

MAX DOSE = 1 cartridge per 10kg of bodyweight for lidocaine/epinephrine

• 1/10th cartridge per KG of bodyweight
• 1/11th cartridge for prilocaine with felypressin

Question 17

What technique adjustment would you make to an IDB for a child?

Answer 17

• angle of mandible of a child is much more obtuse than that of an adult so the ID foramen is found lower
• technique is the same in that the position from the opposing arch is over the deciduous molars rather than the 4/5 adult area
• follow occlusal plane and angle slightly lower
• dose reduction and aspiration is required
• no use of topical anaesthesia for IDB
• give clear POIG to reduce post op trauma

Question 18

What is the rule of 10?

Answer 18

Childs age + number of tooth (d=4, e=5)

If total:

• <10 give infiltration over IDB as bone is more porous so LA will diffuse easier
• > 10 give an IBD