Hats for Teeth

Full Coverage Restorations for Deciduous Teeth

Full Coverage Restorations

Posterior Stainless Steel Crowns
a. Straight sided (Rocky Mountain) b. Pre-contoured & Pre-trimmed (3M) c. Pre-trimmed (3M Unitek) d. Veneered (NuSmile)

Full Coverage Restorations

Posterior Transparent Strip Crowns
a. Pre-contoured & Pre-trimmed (Success Essentials)

Full Coverage Restorations

Anterior Stainless Steel Crowns
a. Unveneered (3M Unitek) b. Veneered (Various)

Transparent Strip Crowns

a. Pre-contoured (3M) b. Pre-trimmed & Pre-contoured (Success Essentials)

Stainless Steel Crowns (versus Complex Intra-coronal Restorations)

Advantages
Ease of preparation Ease of placement Minimal chairside time Excellent durability Low cost Benign periodontal response

Disadvantages
Poor aesthetics Risk of impaction of adjacent erupting permanent tooth

Stainless Steel Crowns - Composition

67% Iron 17% Chromium 12% Nickel 4% Other

Stainless Steel Crowns - Durability

Percentage of restorations requiring replacement prior to tooth exfoliation: Multi-surface amalgams Stainless steel crowns 89% 30%
(Braff, 1975)

Stainless Steel Crowns - Durability

Average length of service (months) Amalgam SSC
45 40 35 30 25 20 15 10 5

(Dawson, Simon & Taylor, 1991)

0 1st Molar 2nd Molar

Stainless Steel Crowns - Durability

Stainless Steel Crowns are predicted to show a success rate which is approximately twice that of a Class II amalgam when placed in children who are younger than 4 years old.

(Messer and Levering, 1988)

Stainless Steel Crowns - Indications

1. Extensive decay in a primary tooth involving

multiple surfaces extension of the proximal box so far axially as to risk pulp exposure extension of the proximal box so far buccally or lingually so as to cause undermining of the cusps

Stainless Steel Crowns - Indications

2. High caries rate/risk

Stainless Steel Crowns - Indications

3. Following pulpotomy or pulpectomy in a primary tooth.

Stainless Steel Crowns - Indications

4.

Severe developmental defects of the teeth

extensive enamel hypoplasia amelogenesis imperfecta dentinogenesis imperfecta vitamin D resistant rickets

Stainless Steel Crowns - Indications

5. Abutment for space maintainer or denture

Stainless Steel Crowns - Indications

6. Failure (or likely failure) of an intra-coronal restoration bruxism

Stainless Steel Crowns - Indications

7. When reliability of the restoration is essential

treatment under GA

Stainless Steel Crowns - Indications

8. Anticipated service life of the primary tooth is long

Stainless Steel Crowns - Indications

9. Following a traumatic coronal fracture involving multiple surfaces in a primary tooth

Stainless Steel Crowns - Indications

10. Severe loss of tooth structure from a cause other than caries erosion

Stainless Steel Crowns

Contra-indications
Imminent exfoliation Insufficient cervical undercut for retention When aesthetics are paramount

Stainless Steel Crowns - Technique

Tooth Preparation

Stainless Steel Crowns - Technique

Crown Selection and Modification

Stainless Steel Crowns - Technique

Crown Cementation

Stainless Steel Crowns - Cement

Ideal Requirements
Adequate compressive and tensile strength High viscosity (film thickness = 1.0 - 1.5mm) Low solubility Appropriate working and setting time Bio-compatible Abrasion resistant (in case of perforation) Bonds to enamel dentine and crown alloy Fluoride release

Stainless Steel Crowns - Cement

Ideal
Glass ionomer cement - restorative material Glass ionomer cement - luting material

Alternatives (Not recommended)

Composite resin Zinc phosphate cement Polycarboxylate cement Zinc oxide cement

Veneered Stainless Steel Crowns

Advantages
Enhanced aesthetics

Disadvantages
Reduced retention Crimping limited to lingual margin Expense Fracture or loss of veneer Autoclaving damages veneer - use unveneered Unitek crown to size

Crown Veneer - Composition

Composite / Dimethacrylate Resin
Cheng NuSmile Kinder

Polyethylene Plastic (Thermoplastic)

Whiter Biter II

Crown Veneer - Attachment

Bonded Directly to Pre-treated 3M Unitek Crown
NuSmile Kinder

Mechanically Retained to a Meshwork, Spot Welded to a 3M Unitek Crown

Cheng

Crown Veneer - Attachment

Mechanically Retained to a modified 3M Unitek Crown and to a Meshwork, Spot Welded to the Crown
Whiter Biter II

Crown Veneer - Shear Strength

Whiter Biter II . is significantly better able to resist a shearing force than the other three commercial crowns tested
(Waggoner and Cohen, 1995)

Cheng . was more resistant to displacement than .Whiter Biter II. This was the . only difference noted in the (4) crowns tested. (Baker, Moon & Mourino, 1996)

Posterior Transparent Strip Crowns

3 dimensional template for the production of an posterior composite crown Published Reports of Use one case report (Ram and Peretz, 2000)

Posterior Transparent Strip Crowns

Advantages
Enhanced aesthetics

Disadvantages
Potential contamination at gingival margins leading to restorations failure Unknown clinical success - no longitudinal studies

Anterior Transparent Strip Crowns

3 dimensional template for the production of an anterior composite crown

Anterior Transparent Strip Crowns

Advantages
Excellent aesthetics Excellent retention

Disadvantages
Potential contamination at gingival margins leading to - restorations failure - compromised aesthetics

Anterior Transparent Strip Crowns

Indications
moderately to severely carious primary incisors discoloured primary incisors developmental defects of the primary incisors crown fractured primary incisors

Anterior Transparent Strip Crowns

Contra-indications
imminent exfoliation persistent periapical pathology