Survival Rate of Maxillary Primary Incisor Rehabilitation Performed Under IVGA

Brett Carranza, DDS

• Clinicians can argue that the method they utilize to restore carious primary incisors is best, but there is actually little scientific evidence to support any claims. (10)

Early childhood caries or baby bottle tooth decay is usually seen between 18-36 month-old children, although it can be seen even younger. Behavior plays a big factor in the survival of the restoration. (11) With these young children, unless they are completely unconscious, as with intravenous general anesthesia, their uncooperative behavior can influence the clinician’s ability to place the restorations under ideal circumstances. (22)

• A retrospective study evaluating the performance of resin bonded strip crowns in 200 children aged 22-48 months were followed up after at least 24 months, found an 80% success rate. (10)

• A success rate of 100% has been reported in the literature where Class III resin-modified restorations were placed and maintained intraorally for almost 4 1/2 years. (5)

• Croll describes stainless steel SSCs to be easy to place, fracture proof, wear resistant, and attach firmly to the tooth until exfoliation. (1)

Research Aim
The aim of this study was to examine the clinical and radiographical success of the treatment of maxillary primary incisors restored with composite resin strip crowns (SC’s), stainless steel crowns (SSC’s) and class III composites completed under intravenous general anesthesia at the UCLA Children’s Dental Center.

Study hypothesis
Alternative hypothesis: Stainless steel crowns followed by strip crowns and then class III resins will have the longest longevity. Null hypothesis: There will be no difference between restoration type and the longevity of the restoration

Materials & Methods
Study type:Retrospective chart review

Study population: Patients between age of 2-5 treated at the UCLA CDC under IV general anesthesia, who received restorative treatment of primary incisors during the years of 20052010.

Research design
Inclusion criteria: •Patients who had anterior class III composites, strip •crowns or stainless steel crowns placed in the primary dentition. Patients who were seen under IV general anesthesia for dental treatment between 2005 and 2010. •Patient must have been followed for at least one year after initial treatment.

Research design
Exclusion criteria: •Patient seen for follow up but did not have radiographs during the follow up visits •Dental charts without proper documentation of procedure performed

• • • • • • Restoration lasting until exfoliation Restoration lasting until the last follow up

FAILURE: Repair or replacement due to recurrent caries Loss of restoration Restoration needing extraction

Methods Dental charts were reviewed

• Radiographs were reviewed independently by Brett Carranza and Dr. Silva • Radiographs were evaluated for the quality of the margins, recurrent caries, and the presence of pulpal and/or periapical pathologies.

• When there was a disagreement in the assessment, the radiographs were reviewed and a consensus was reached. Number of carious surfaces present before the treatment as well as the location of decayed surfaces in the treated tooth were recorded. • The pre-treatment radiographs were evaluated for which surfaces (buccal, mesial, lingual, distal) were affected by caries disease.


A Chi-Square test was used to analyze the data.

• 40 patient charts were reviewed • 109 restorations

• 59 SCs, 12 SSCs and 38 Cl III composites

• • Total survival rate = 60% survival rate per type of treatment • • • SCs = 61% SSCs = 75% CL III composite = 53%

• Compared to the literature the success rate for each restoration was significantly lower • Technique and case selection play a significant role in the longevity of the restoration

• SSC had the highest survival rate followed by SC and then CL III composites

•Shiflett K, White SN. Microleakage of cements for stainless steel crowns. Pediatr Dent. 1997 (2)

•Carranza F, García-Godoy F. Esthetic restoration of primary incisors. Am J Dent. 1999 (3)
•Grosso FC. Primary anterior strip crowns J Pedodont. 1987 (4)

•Croll TP, Bar-Zion Y, Segura A, Donly KJ. Clinical performance of resin-modified glass ionomer cement res•torations in primary teeth. JADA. 2001 (5)


•Piyapinyo S, White G. Class III cavity preparation in primary anterior teeth: in vitro retention comparison of
•conventional and modified forms. J Clin Pediatr Dent. 1998 (6)

•Waggoner WF. Restorative dentistry for the primary dentition. In: Pediatric Dentistry: Infancy Through Adolescence. 2nd ed. Pinkham JR, ed. Philadelphia: WB Saunders Co; 1994 (7)

•Wiedenfeld K, Draughn R, Welford J. An esthetic technique for veneering anterior stainless steel crowns with
composite resin. ASDC J Dent Child. 1994 (8)

•Baker LH, Moon P, Mourino AP. Retention of esthetic veneers on primary stainless steel crowns. J Dent Child (9) •Kupietzky A , Waggoner WF, Galea J. The clinical and radio- graphic success of bonded resin composite strip
crowns for primary incisors. Pediatr Dent 2003 (10)

•Lee JK. Restoration of primary anterior teeth: Review of the literature. Pediatric Dent 2002 (11) •Edelstein B. How outcomes and evidence can strengthen the role of the pediatric dentist. Pediatr Dent. 1998 (12) •Waggoner WF, Cohen J. Failure strength of four veneered primary stainless steel crowns. Pediatr Dent. 1995 (13) •Al-Shalan TA, Till MJ, Feigal RJ. Composite rebonding to stainless steel metal using different bond- ing agents.
Pediatr Dent. 1997 (14)

•Baker LH, Moon P, Mourino AP. Retention of esthetic veneers on primary stainless steel crowns. ASDC J Dent
Child (15)

•McKnight-Hanes C, Myers DR, Davis HC. Dentists’ perception of the variety of dental services provided for
children. ASDC J Dent Child. 1994 (16)

•Croll TP. Bonded composite resin crowns for primary incisors: technique update. Quintessence Int. 1990 (17)

•Judd PL, Kenny DJ, Johnston DH, Yacobi R. Com- posite resin short-post technique for primary anterior teeth.
JADA (18)


•Stewart R, Luke L, Pike A. Preformed polycarbonate crowns for the restoration of anterior teeth. JADA (19) •Feigal RJ. Advantages of new restorative materials in dental care for children. J Mich Dent. 1999 (20) •Crall JJ. Pediatric dental treatment outcomes: the importance of multiple perspectives. Pediatr Dent. 1998 (21) •Almeida AG, Roseman M, Sheff M, Huntington N, Hughes CV. Future caries susceptibility in children with early
childhood caries following treatment under general anesthesia. Pediatr Dent. 2001 (22)

•Tinanoff, N, Daley N, O’Sullivan DM, Douglas JM. Failure of intense preventive efforts to arrest early child - hood
and rampant caries: three case reports. Pediatric Dent. 1999 (23)

•Grosso FC. Primary anterior strip crowns J Pedodont. 1987 (24) •De Araujo FB, García-Godoy F, Issao M. A compari- son of three resin bonding agents to primary tooth dentin.
Pediatr Dent. 1997

•Corniff JN, Hamby GR. Preparation of primary tooth enamel for acid conditioning. ASDC J Dent Child. 1976