2010 national primary oral health conference … national primary oral health conference october...
TRANSCRIPT
The use of stainless steel
crowns on primary molars
2010 National Primary
Oral Health Conference
October 24-27
Gaylord Palm Orlando Florida
Enrique Bimstein
Professor of Pediatric Dentistry
University of Florida College of Dentistry
The use of SSC on primary molars
The participants will become
familiar with the basic
knowledge and procedures
required for the restoration
of primary molars with
preformed stainless steel
crowns
Goal
Topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures
tooth preparation crown adaptation
and cementation
4 Summary and conclusions
Cast Gold crowns
Stainless steel occlusal anatomy
trimmed
contoured
pre-veneered
Composite plastic matrix
Crown types for primary teeth
Cast crowns - gold
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
The use of SSC on primary molars
The participants will become
familiar with the basic
knowledge and procedures
required for the restoration
of primary molars with
preformed stainless steel
crowns
Goal
Topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures
tooth preparation crown adaptation
and cementation
4 Summary and conclusions
Cast Gold crowns
Stainless steel occlusal anatomy
trimmed
contoured
pre-veneered
Composite plastic matrix
Crown types for primary teeth
Cast crowns - gold
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures
tooth preparation crown adaptation
and cementation
4 Summary and conclusions
Cast Gold crowns
Stainless steel occlusal anatomy
trimmed
contoured
pre-veneered
Composite plastic matrix
Crown types for primary teeth
Cast crowns - gold
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Cast Gold crowns
Stainless steel occlusal anatomy
trimmed
contoured
pre-veneered
Composite plastic matrix
Crown types for primary teeth
Cast crowns - gold
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Cast crowns - gold
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Cast crowns - gold
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Cast crowns - gold
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Preformed metal crowns
or stainless steel crowns
(SSC) have been in use for
about 60 years
bull SSC are an invaluable
restorative material in the
treatment of badly
decayed primary teeth
Stainless steel crowns
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Full coverage
metallic
definitive
restoration for
primary teeth (Or temporary for
permanent teeth)
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth
Definition of SSC
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Perio health
of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good Good
Several One
Hours Minutes
Difficult Easy
Yes No
Expensive Cheap
ldquoBadrdquo ldquoBadrdquo
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
is clear in your mind
Rationale for using a SSC
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Rationale for using a SSC
The use of SSC is indicated in
cases in which the prognosis for
long term success of ldquoregularrdquo
restorations is reduced by a high
possibility of
a restoration fracture
b recurrent caries
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Extensive caries destruction
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp
Indications for using a SSC
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
No gingival floor possible for a
proximal ndash occlusal restoration
Sidney B Finn Pediatric Dentistry book
Indications for using a SSC
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Early childhood caries Indications for using a SSC
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
High caries incidence Indications for using a SSC
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Indications for using a SSC
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
After endodontic treatment
Indications for using a SSC
Pulpectomy
Pulpotomy
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Pulpectomy
Pulpotomy
After endodontic treatment
Indications for using a SSC
A
l
w
a
y
s
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years Holan et al Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam Pediatr Dent 24212 2002
Indications for using a SSC
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Enamel hypoplasia
Enamel hypoplasia and caries
Delopmental abnormalities
Indications for using a SSC
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Compliance and behavior
Indications for using a SSC
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Space maintainer
As an abutment for space
maintainers or prosthetic
appliances
Indications for using a SSC
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Fractured molars due to trauma Tejani Z Johnson A
Mason C Jane
Goodman J Multiple
crown-root fractures in
primary molars and a
suspected subcondylar
fracture following
trauma a report of a
case Dental Traumatology 2008 24 253ndash256
Indications for using a SSC
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Multi-surface restorations
Indications for using a SSC
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Preformed metal crowns
demonstrate greater
longevity and reduced re-
treatment need compared
with (multi-surface)
amalgam
Indications for using a SSC
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
The literature demonstrates evidence
of a more favorable outcome for SSCs
than for amalgam restorations in
primary molars requiring multi-surface
restorations
10 Studies 16 to 10 years follow-up
failure rates ranged from 19 to 303
for SSCs and 116 to 887 for
amalgam restorations Efficacy of preformed metal crowns vs amalgam restorations in primary molars a
sistematic review JADA 131337-43 2000
Indications for using a SSC
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
1st primary
molar
2nd primary
molar
One surface
restorations
70 32
Two surface
restorations
75 714
Stainless
steel crowns
128 110
Dawson et al ASDC J Dent Child 1981
Failure before the age of 8 years
Indications for using a SSC
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
1 Type of tooth (first vs second molar)
2 Dental age of patient
3 Caries incidence
4 Patientrsquos compliance (brushing etc)
5 Water fluoridation
6 Bucco-lingual extent of cavity
7 Other (esthetics parents compliance etc)
Multi-surface restorations VS SSC
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Primary tooth close to exfoliation
Contraindications for SSC
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Contraindications for SSC
2 Extensive dental caries
a there is not enough
crown structure left
b the caries (gingival)
extent does not allow
for adaptation
c excessive mesial drift
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
No restorability due to
extensive crown destruction
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
No restorability due to
caries gingival depth
Contraindications for SSC
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
No restorability due to
excessive mesial drift
Contraindications for SSC
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
3 Esthetics
Contraindications for SSC
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
4 Allergy to nickel
Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 17-19
chromium 9-13 nickel and 008-01 carbon
Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76 nickel 8 iron 004
carbon and 035 manganese MS Muthu- N Sivakumar Pediatric Dentistry Principles and practice Elsevier 2009
Contraindications for SSC
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
4 Allergy to nickel
Nickel is one of the most common
causes of allergic contact dermatitis
and produces more allergic reactions
than all other metals combined There
may be a risk of sensitizing patients
to nickel with long-term exposure to
nickel-containing appliances as in
orthodontic therapy Bass JK Fine H Cisneros GJ Am J Orthod Dentofacial Orthop 1993 Mar103(3)280-5
Contraindications for SSC
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
4 Allergy to nickel ()
Nickel has its
problems with human
biochemistry
Children have to start
wearing glasses within
a few months of
receiving the crowns
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
4 Allergy to nickel ()
If your child becomes
cranky and misbehaves
after the crowns were
placed while previously
he had a pleasing
personality check it
out
Contraindications for SSC
httpwwwhugginsappliedhealingcomstory5php
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Characteristics of SSC
Stainless steel crowns may
be with
Occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal anatomy only (Unitek)
They require trimming
contouring and crimping
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
Characteristics of SSC
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Oclussal and pre-trimmed (Unitek)
bull Festooned to allow a line
parallel to the gingival crest
bull They require
contouring
and
crimping
Characteristics of SSC
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal pre-trimmed and pre-
contoured (Ion-Nichro)
bull Some trimming contouring and
crimping may be necessary
bull When trimmed re-contouring
crimping and polish are required
Characteristics of SSC
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Characteristics of SSC
ION Ni-Chro 3M Stainless steel
ION Ni-Chro 3M Stainless steel
Shape
Length
Cervical
constriction
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Pre-veneered metal with esthetic facing
(NuSmile)
Characteristics of SSC
bull Have a resin-composed facing
bonded to Occ and B surfaces
bull Expensive require more tooth
reduction and allow only for
minimal crimping
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Rationale for SSC tooth
preparation and adaptation
Flexibility easily bent or shaped
Elasticity the tendency of a body to
return to its original shape after it
has been stretched
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crownrsquos
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Preformed metal crowns are flexible and
elastic (they snap)
Rationale for SSC tooth
preparation and adaptation
bull The tooth cervical bulge is ldquosurroundedrdquo
by the crown
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Rationale for SSC tooth
preparation and adaptation
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
a do not require the retention
features that are incorporated in
cavity design of cast crowns
b obtain their retention from the
flexibility and elasticity of the
thin contoured and crimped
crown margins and
cementation
Rationale for SSC tooth
preparation and adaptation
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Subgingival depth
Rationale for SSC tooth
preparation and adaptation
C E J
asymp 15 mm
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Clinical procedures for SSC
bull Rationale
bullTooth preparation
bull Crown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Check Occlusion before
starting tooth reduction
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Armamentarium - Burs
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
114
plier
Crimping
plier
Sharp
scaler
Round
scissors
Armamentarium for adaptation
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Tooth preparation for SSC
bull General considerations
Extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
(1-15 mm reduction)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal preparation (a)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Create a ldquochannelrdquo 125 mm deep
between the cusps
Occlusal preparation (a)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Reduce the cusps to the depth of the
channel
Occlusal preparation (a)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal preparation (b)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal preparation (b)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Occlusal preparation (b)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bull Proximal surfaces
bull Finish
Tooth preparation for SSC
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Tooth preparation for SSC bull Buccal and lingual surfaces
a)Limited to occlusal 13 of the B
amp L surfaces at a 45ordm bevel
b)Round off all line angles
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Buccal and lingual reduction
Prepare a slight bevel at the occlusal 13
portion of the surface
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Whatrsquos next
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Caries removal
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Apply a liner or perform
pulp therapy
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Tooth preparation for SSC
bull General considerations
Depth and extent
Caries removal
Pulp treatment
bull Occlusal surface
bull Buccal and lingual surfaces
bullProximal surfaces bull Finish
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Tooth preparation for SSC
Proximal surfaces a) 169L tapered fissure or thin tapered
diamond bur
b) Break proximal contacts at appropriate
depth in single sweeping motion (or
gradually)
c) Vertical proximal walls with slight
convergence in an occlusal and
lingualpalatal direction
d) Feather-edge finish line common
error ledge formation
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal reduction ldquoopenrdquo the
proximal contacts flat surfaces
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal surfaces
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal surfaces
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal surfaces
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Rounding angles
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Rounding angles
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Clinical procedures for SSC
bull Rationale
bull Tooth preparation
bullCrown selection
bull Crown adaptation
bull Complications
bull Cementation
bull Cleaning
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
3M Stainless steel
3M Stainless steel
SSC selection
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
a)Place or ldquoseat crownrdquo from
lingual to buccal
b)Push crown over the buccal
buldge for a snap fit
c)Check margins for close
cervical adaptation extending
1-15 mm subgingivally
(blanching)
General considerations
SSC selection
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC selection
1 Choose the crown that fits
MD
Select the smallest crown that
restores the pre-existing
contacts (if present)
The most common used
crowns are size 4
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC selection
Too small M-D
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC selection
Too big M-D
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Radiograph in
which crown
adaptation is
adequate in
tooth 64 and
inadequate in
65 and 74
SSC selection
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth
SSC selection
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Contour
Crimping
Crown adaptation
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
114 Contouring Pliers
Crown adaptation
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Buccal and lingual
Crown adaptation
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal
Crown adaptation
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Proximal
Crown adaptation
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
ldquoExtrardquo countour
Crown adaptation
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crown adaptation
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crimping Pliers
Crown adaptation
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crimping Pliers
Crown adaptation
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Crimping Pliers (extra crimping)
Crown adaptation
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Examine the crown for sharp angles
or irregularities Re- contour andor
re-crimp were necessary
Crown adaptation
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
The occlusion
should be the
same before
starting the
procedure
Examine the occlusion
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC Cementation and cleaning
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC Cementation and cleaning
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Complications
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
To crown is too long bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Sharp scaler
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Crown and Bridge Scissors
Additional crown adaptation
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Crown and Bridge Scissors
Additional crown adaptation
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Polish the crown
with a heath less
stone
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
bull Buccal and lingual surfaces
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Due to carious proximal contact loss
the crown that fits M-D may be too
small B-L this may be solved with more
buccal or lingual reduction
Additional crown adaptation
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Too high
Fits MD but does not cover the buccal
surface modify a larger crown bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Too high
Over the gingiva (or loose) bull over the gingiva
bull no space with antagonist
bull no space interproximal
bull sharp angles
Additional crown adaptation
Additional
contour
andor
crimping
are
required
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Howe Plier to rotate crowns
Additional crown adaptation
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Aspiration Complications
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Aspiration Complications
Adewumi A Kays DA Stainless steel crown aspiration during
sedation in pediatric dentistry Pediatr Dent 3059-62 2006
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Gingival and periodontal diseases
Complications
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Complications Allergy The nickel content in the
formulation of nickel
chromium crowns is around
70 greater than that of
contemporary stainless steel
crowns that contain 9-12
nickel similar to that of many
orthodontic band and wires
httpwwwslidesharenetden
tistryinfostainless-steel-
crown
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Complications Allergy Pazzini CA Pereira LJ Marques LS Generoso R de Oliveira G
Jr Allergy to nickel in orthodontic patients clinical and
histopathologic evaluation Gen Dent 2010 Jan-Feb58(1)58-61
Kolokitha OE Chatzistavrou E A severe reaction to ni-containing
orthodontic appliances Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions Nickel
is the most typical antigen implicated in causing allergic contact
dermatitis which is a Type IV delayed hypersensitivity immune
response Angle Orthod 2009 Jan79(1)186-92
Bruce GJ Hall WB Nickel hypersensitivity-related periodontitis
Compend Contin Educ Dent 1995 Feb16(2)178 180-4 quiz
186
Ehrnrooth M Kerosuo H Face and neck dermatitis from a
stainless steel orthodontic appliance Angle Orthod 2009
Nov79(6)1194-6
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Pre-veneered metal with esthetic facing
bull have a resin-composed facing
bonded to O and B surfaces
bull expensive require more tooth
reduction and allow only for
minimal crimping
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Ram D et al Long-term
clinical performance
of esthetic primary
molar crowns At the 4
year evaluation all the
esthetic crowns (n=10)
showed chipping of
the esthetic facing
with poor esthetic
appearance Pediatr Dent 25582-4 2003
Pre-veneered metal with esthetic facing
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Composite crowns
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Composite crowns
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
SSC in primary teeth topics
1 Introduction
crown types definition rationale
indications and contraindications
2 Characteristics advantages and
disadvantages
3 Clinical procedures tooth
preparation crown adaptation and
cementation
4 Summary and conclusions
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
Summary and conclusions
SSCs represent a long term easy
one appointment full coverage
restorations of primary molars
The tooth preparation and
adaptation are relatively easy in
most cases
Durable and cost effective ($34
for 5)
