STAINLESS STEEL CROWNS

Dr. ANKITA ARORA

CONTENTS

INTRODUCTION

CLASSIFICATION AND TYPES

INDICATIONS AND CONTRAINDICATIONS

SELECTION OF CROWN

TOOTH PREPARATION

CEMENTATION OF CROWN

MODIFICATIONS

COMPLICATION

CONCLUSION
INTRODUCTION
 The importance of primary teeth should be
considered in helping speech, mastication,
maintaining arch length and cosmetic
function

 natural space maintainers for the permanent

teeth

 Stainless crowns has become an important

factor in the restoration of the extensively
carious lesion and Following the treatment
of, pulpally involved teeth by maintaining
arch integrity for the permanent teeth
 The term “stainless steel” is used when the chromium content
exceeds 11% and is generally in the range of 12 to 30%.

 Chromium oxidizes and forms a thin surface film of chromium

oxide (Cr2O3), known as “passivating film” which protects against
corrosion

 nickel (7-22%.), and carbon (0.25%).

 Stainless steel crowns contain about 18% chromium and 8% nickel

CLASSIFICATION OF STAINLESS STEEL CROWN

• BASED ON THE SHAPE

Precontoured crowns

 (e.g. Ni-Cr Ion crowns and Unitek stainless steel crowns).

 These are the latest evolution in the crown modification to adapt

easily to the tooth.
 These crowns are festooned and are also precontoured although a
minimal amount of festooning and trimming may be necessary.
Made up softer metal, but designed to snap over preparation
without any alterations.
INDICATIONS OF STAINLESS STEEL CROWN

1. EXTENSIVE DECAY IN PRIMARY TEETH ( muslisurface caries)

2. FOLLOWING PULP THERAPY
3. FOR TEETH WITH DEVELPOMENTAL DEFECTS- amelogenesis and
dentinogenesis imperfecta
4. AS AN ABUTMENT FOR A SPACE MAINTAINER
5. RESTORATION OF TEETH IN CHILDREN WITH RAMPANT CARIES
6. BRUXISM
7. CORRECTION OF ANTERIOR CROSS BITE
The use of stainless steel crowns- CONFERENCE
PAPER
Recommendations- BY AAPD
• Children at high risk exhibiting anterior tooth decay and/ or
molar caries may be treated with ss crown to protect the
remaining at – risk tooth surface
• Children with extensive decay , large lesions or multisurface
caries should be treated with ss crowns
• Strong considerations to children who require GA.

Seale S, pediatric dentistry 2002

 CONTRAINDICATION OF STAINLESS STEEL CROWN

More than two thirds of the roots are resorbed

The tooth exhibits excessive mobility
 Primary tooth is approaching exfoliation; i.e., X-ray shows
over half the primary tooth root resorbed. .

 Patients with nickel allergies

Placement of stainless steel crowns on these patients cause a
localized and systemic allergic reaction.
ARMAMENTARIUM

• Burs and stones

• No 169L
• No 6
• No 33O
• Tapered diamond
• Green stone or heatless stone
• Wire wheel
• Pliers and instruments
• No 114 Johnson plier
• No 137 Gordon pleir
• Sharp Scaler or instrument
• Crown and bridge scissors
• Rubber dam armamentarium.
• No 11O Howe plier
PRELIMINARY BUT VITAL STEPS…

• CHECK OCCLUSION
• ADMINISTER LA
SELECTION OF CROWN

Three main considerations in selecting the proper stainless steel crown

are
 Adequate mesiodistal diameter
 Light resistance to seating
 Proper occlusal height.

A correctly selected crown, prior to trimming and contouring, should

cover the tooth preparation and provide resistance to removal

MATHEWSON
TOOTH PREPARATION

N0. 330 OR a tapered diamond bur , 1- 1.5 mm clearance

 PROXIMAL REDUCTION

Knife – edge finish line

 Crown adaptation
Try the crown on the tooth. Place the crown on the lingual side and rotate it
toward the buccal side in mandibular arch and in maxilla the crown is placed on
buccal side and rotated towards palatal side

Mark gingival margin with scaler Trim 1mm below marked scratch
CROWN ADAPTATION

CONTOUR WITH NO. 114 PLIERS CRIMPING

CROWN FINISHING
CEMENTATION
VARIOUS CEMENTS USED FOR CROWN
CEMENTATION

• Zinc phosphate cement

• ZINC OXIDE EUGENOL CEMENTS And
REINFORCED ZINC OXIDE EUGENOL CEMENTS
• POLYCARBOXYLATE CEMENT
• GLASS IONOMER CEMENT
CAUSES OF STAINLESS STEEL CROWN FAILURE

 Poor tooth preparation

 Poor crown adaptation and subsequent poor retention.
 Improper cementation methods with lost crowns or open
margins.
 Failure of the pulp treatment.
 Induced ectopic eruption of the permanent first molar.
 Recurrent caries, especially in the interproximal areas.
 Crown abrasion through the occlusal surface.

Mathewson
 CLINICAL MODIFICATIONS
ADJACENT STAINLESS STEEL CROWNS
o prepared at the same time
 cemented at the same time
 ( An increase in the amount of cement
may be needed)
 Checked for proper broad contacts.
 To get these adjustments, adapt and seat
the crown on the most distal tooth first
and proceed mesially.
 When multiple posterior crowns are to
be seated, they should be adapted and
cemented simultaneously to allow for
adjustments in the interproximal spaces
and establish proper contact areas.
Stainless steel crown and a class II amalgam
restoration
• stainless steel crown preparation is done first
• However Class II amalgam preparation is done at same time to allow
for proper contour of the stainless steel crown’s marginal ridge.
• The stainless steel crown is used as a guide in reproducing the
anatomy and morphology of the silver amalgam restoration
..
 ADJACENT STAINLESS STEEL CROWNS WITH
ARCH LENGTH LOSS (Mc EVOY 1977)
• The tooth preparation must
compensate for the need to use a
small crown
• Usually crowns will adjust to the tooth
preparation individually but cannot be
placed at the same time because of
the mesial drift of the adjacent teeth
• Reduce crown preparations further ,
as pulp exposure is not a problem in
pulp treated teeth
• By experimentation optimum combination of crowns are selected. A
primary maxillary first molar from the opposite side will fit a primary
mandibular first molar of the opposite side. Anatomically there is a
similarity, advantage being that the primary maxillary first molar
crown is narrower mesiodistally
• Contacts are flattened using HOWE no 110 plier. When the crowns
are cemented, the marginal edges should be aligned. Use HOWE no
110 plier , before the cement sets.
• the crowns properly aligned, patient bite on a tongue blade until the
cement is completely set.
MODIFICATION OF THE STAINLESS STEEL
CROWN SIZE
• OVERSIZED CROWN
UNDERSIZED CROWN
CROWN EXTENSION FOR DEEP PROXIMAL
LESIONS
THE OPEN CONTACT

• Inability to establish a closed contact area will result in food

packing, increased plaque retention and subsequently
gingivitis.

• Selection of larger crown will solve this problem.

• Localized addition of the solder can also build out the

interproximal contour.
 COMPLICATIONS OF SS CROWN

INTERPROXIMAL LEDGE
• Incorrect angulation of the tapered
fissure bur can produce a ledge instead
of a shoulder free slice.
• Further tooth reduction to remove the
ledge should be attempted cautiously
because of the possibility of an
iatrogenic pulpal exposure. Failure to
remove the ledge will result in inability
to seat the crown whose margins will
bind on the ledge.
 CROWN TILT
•Destruction of a simple lingual or buccal
wall by caries or overzealous use of cutting
instrument may result in the finished
crown tilting towards the deficient side.
Lack of tooth support encourages this
tilting.
•Placement of an amalgam alloy or glass
ionomer cement prior to crowning
provides support to prevent crown tilt.
• POOR MARGINS
The marginal integrity of the crown is reduced when it is
imperfectly adapted. As the marginal discrepancy
increases the chance of plaque retention and gingivitis.
• AESTHETICS
Sometimes parents complain about the appearance of
the metal crown as being ugly. In these cases a
mesiobuccal facing can be placed after the crown has
been cemented into place.
• INHALATION OR INGESTION OF THE CROWN
These accidents are rare, particularly when rubber dam is used .
sudden unpredictable movement may result in inhalation or ingestion of
the crown if the rubber dam is not in place.
If this occurs an attempt to removal can be made by holding the child
upside down as soon as possible, if this is unsuccessful referral for an
immediate chest X-ray is mandatory.
The presence of a cough reflex in the conscious child fortunately reduces
the chances of inhalation, ingestion of the crown.
STAINLESS STEEL CROWN FOR PERMANENT
MOLAR
• Indications:
• The stainless steel permanent crowns can be used to make a useful long term
provisional restoration for a broken down first permanent molar that has been
partially restored and must be kept under observation before construction of a
cast restoration.
• The crowns are useful for restoring the occlusion and greatly reducing the
sensitivity from enamel and dentine dyscrasias in young patients.
• When there are financial considerations regarding the need for a cast
restoration, placement of a stainless steel crown may be considered as an
economical.
• For full coverage in young posterior teeth that have enamel or dentinal
abnormalities.
Facial cut out OR open faced ss crowns

• Window prepared on cemented ss crown and

composite placed thereafter
• Adv :- esthetics
• Disadv:- 2 step proedure
• Moisture control imp,
• Facings can fracture , though durability is good.
• Some amount of metal still visible.
 Veneered stainless
steel crowns

• Composite resin and

thermoplastics are bound
to the metal.
• Adv:- pleasing esthetics, short clinical time, when moisture
control is difficult for resin
• Disadv:- resin- metal interface #, crimping can # veneers,
expensive
•
Commercial brands

Kinder
crowns
Dura –
Nusmile
crown

Cheng Whiter
crowns biter-II
Marginal adaptation of stainless steel crowns

• Croll T. Pediatric dentistry 25:3 , 2003

 • IMPACTED adjacent 2nd
premolar and 2nd molar –
serious malocclusion

Croll T. Pediatric dentistry 25:3 , 2003

 Goal -
• Contour , finish and polish edges of
the crown so that they curve
smoothly towar d the tooth surface
circumferentially , replicating natural
cervical contours of enamel at the
crown/ root interface

Croll T. Pediatric dentistry 25:3 , 2003

A heatless stone used for trimming crown The crimping pliers bends edges inwardly.
margins to proper length

Rotating counterclockwise, the heatless stone

A rubber wheel smoothes thins the margin and applies a “minicrimp” to
crimped margins. crown edges.
 Final finishing and polishing completed on
lathe with Tripoli and jeweler’s rouge on
cloth wheels.

A finished and polished stainless

steel crown form ready for
cementation (left) and before
adaptation (right).
REFERENCES:-

• Dentistry for children and adolescent, MacDonald, Avery

• Kennedy’s paediatric operative dentistry
• Fundamentals of pediatric dentistry, 3rd edition, Richard J Mathewson
• Comprehensive pediatric dentistry, Nikhil Marwah
• Textbook of pedodontics – Shobha Tandon
• Marginal adaptation of Stainless Steel Crowns: Theodre P Croll et al, Pediatric Dentistry: 25: 3; 2003
• Parental Satisfaction with pre veneered Stainless Steel crowns for primary anterior teeth. Cariann
Champagne et al. PD 2007:29;6