1. Stainless Steel Crowns

2. STAINLESS STEEL CROWNS
First used in the late 1940s and became commonly used in the 1960s
Gained popularity and acceptance along with the idea of “pediatric dentistry”

3. Pediatric Dental Literature
The Use of Stainless Steel Crowns
Seale, NS; Pediatric Dent Sept-Oct;24 (5):501-5

4. Advantages of Stainless Steel Crowns
Can be used for badly broken down crowns
Can be placed with poor isolation
Fast
Economical
Full coverage-prevents recurrent decay
Durable

5. Success of SSC Vs. Amalgam in Primary Molars
Combined 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

6. Evidence For General Dentistry
Longevity of Occlusally-Stressed Restorations in Posterior Primary Teeth
Hickel,R et al: Am J Dent 2005 Jun;18(3):

7. Hickel Article Reviewed Literature 1971-July 2003
Clinical performance of restorative materials in primary teeth.
Observed for a minimum of 2 years

8. Hickel Findings (failure rates)
14% Stainless Steel Crowns
35.5% Amalgam
25.8% Glass Ionomer
29.1% ART (Atraumatic Rest. Tx)
*SSC failures usually failure of overall tx i.e. tooth required extraction.

9. 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.

10. Threlfall Study
General 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.

11. Threlfall Study N=93
71% 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.

12. Reasons Given for Not Placing Stainless Steel Crowns
Time Consuming to Fit
Difficult to Manipulate
Expensive

13. Reasons Given for Not Placing Stainless Steel Crowns
Time Consuming to Fit
Difficult to Manipulate
Expensive
Ugly!!!!!!

14. Disadvantage of SSC Time Consuming Difficult to Manipulate Expensive
Ugly

15. Stainless Steel Crowns are Fast!!!
Most pediatric dentists can place one in 10 minutes or less-you can too!

16. Stainless Steel Crowns are just as easy to manipulate as a matrix band!

17. Stainless Steel Crowns are Economical
You decide the fee
Best chance of one appointment treatment.

18. 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

19. What About Gingival Health?
“Plaque accumulation and frequency of gingival problems associated with SSCs in primary teeth seem to be unexceptional”
Some increased inflammation is seen in permanent dentitions after puberty.
Fayle. Int J Paediatr Dent

20. Stainless Steel Crowns (SSC)

21. Indications: Primary Teeth
After pulpal therapy

22. SSC Indications
Following Pulp Therapy

23. Indications: Primary Teeth
After pulpal therapy
Multi-surface carious lesions

24. SSC Indications
Large, Deep Caries
Caries on 3 or more surfaces

25. Indications: Primary Teeth
After pulpal therapy
Multi-surface carious lesions
Proximal box extended beyond ideal

26. SSC Indications
Large, Deep Caries
Caries on 3 or more surfaces

27. Indications: Primary Teeth
After pulpal therapy
Multi-surface carious lesions
Proximal box extended beyond ideal
Restoration of caries in high risk caries patients

28. Indications: Primary Teeth
After pulpal therapy
Multi-surface carious lesions
Proximal box extended beyond ideal
Restoration of caries in high risk caries patients
Teeth with extensive attrition

29. Indications: Primary Teeth
After pulpal therapy
Multi-surface carious lesions
Proximal box extended beyond ideal
Restoration of caries in high risk caries patients
Teeth with extensive attrition
Behavioral Challenges

30. Indications: Permanent Teeth
Interim restoration until a more permanent restoration can be done
Financial barriers prevent gold or PFM crown
Extensive developmental defects. Restore occlusion and reduce sensitivity due to enamel and dentin dysplasia.

31. SSC Indications 1st Permanent Molars Large, Deep Caries
Enamel Hypoplasia
1st Permanent Molars

32. 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

34. Problems with “White” SSCs
White facing prone to fracture and loss
Tooth must be reduced significantly more than conventional SSC prep- therefore, pulp exposure more likely
Cannot crimp or trim as much as conventional SSC

35. Stainless Steel Crown Technique

36. Anatomical Differences
Primary vs. Permanent
Enamel Thickness
Dentin Thickness
Pulpal Size
Gingival Bulge

37. View of Buccal Cervical Bulge: This is what retains an SSC

38. Buccal Cervical “Sweetspot”: This is the critical area for retention

39. Prep (L) vs. No Prep (R): “Sweetspot” Remains

40. SSC Technique Proper Crown Fit: There are no crown margins
The SSC fits over the remaining crown and adapts with a crimped contour.

41. Proximal Contacts Must be Well Broken
Ledges prevent SSC from telescoping over the tooth

42. Rubber Dam “Slit Technique”

46. The “Sloppy Box” Technique
Stainless Steel Crown Preparation

47. Cut an MOD Prep #330 Bur

48. Reduce Occlusal 45 Degrees 1/8 A Diamond Bur

49. Lingual Cusp Reduction-Use Base of MOD Prep as Guide

50. 1-1.5 mm Buccal Counterbevel

51. Lingual Counterbevel

52. Round Proximal Box From Line Angle to Line Angle

53. Mesial Prep Complete/Distal Not Complete

54. Note: No Gingival Seat Ledge Remains on Mesial!

55. Distal Prepped: No Ledges

56. SSC Technique

57. Note: Rounded Line Angles

58. Occlusal Reduction: Adequate for Height of SSC ~1-1.5 mm

59. Select SSC for Mesial-Distal Space: Usually Rocks on From Lingual to Buccal

60. Should “Snap” into Place Over Cervical Bulge

61. Check for Open Margins

62. Remove With Sturdy Instrument

63. Crimping To Adapt Margins

64. Band Contouring Plier

65. Note: Adapted Margins

66. Uncrimped vs. Crimped

67. Patient Bites Into Occlusion

68. Confirm Occlsion

69. “Depth Groove” Technique

70. Depth Groove Technique #K

71. Cut Occlusal Guides #330 Bur

72. Occlusal Depth Grooves

73. Connect Depth Grooves

74. Connecting Depth Grooves

75. Placing Counterbevel

76. Counterbevels Complete

77. Slicing Proximals

78. Prep Complete

79. Finishing Steps The Same