DEPARTMENT OF PEDIATRIC

AND PREVENTIVE DENTISTRY

ANTERIOR ASTHETIC CROWN

SUBMITTED TO: DEPARTMENT OF PEDIATRIC AND
PREVENTIVE DENTISTRY
SUBMITTED BY: ANSHU RAJ
ANUJ SINGH
ANUSHKA AGARWAL
APARNA KUMARI
ARINDHAM BORAH
CONTENTS:
 Anterior Stainless Steel Crowns and facial cut
out stainless steel crown
 Preveneered Stainless Steel Crowns
 Bonded Crown
 Strip Crowns
• Shell Crowns
 • Recent Developments for Anterior Crowns in
Pediatric dentistry
ANTERIOR STAINLESS STEEL CROWNS
• Stainless steel crowns are considered to be the
most durable, economical and reliable for
restoring severely carious and fractured primary
incisors.
• They are easy to place, fracture proof, wear rnt
and attached firmly to tooth until exfoliation.
• However, there is a compromise in esthetics due
to sightly silver metal appearance.

FACIAL CUT OUT STAINLESS STEEL CROWN

• These are indicated in maxillary canines
where strength is a major requirement as
compared to esthetics.
• The labial portion of anterior stainless steel
crown is removed and composite is placed in
the labial fenestration of stainless steel crown
(SSC) as a facing thereby providing adequate
strength and acceptable esthetics.
• Although there is an improvement in the
appearance, the technique is time consuming
and metal margins are still visible
• The disadvantage of these crowns is that
they are not easily removed.
Technique:
Placement of SSC with composite facing:
(A)Remove decay with slow speed handpiece; (B) After restoration or RCT
reduce the facial surface by 1 mm and lingual by 0.5 mm creating a feather
edge gingival margin; (C) Try the crown; (D) Trim the crown for fit; (E) Contour
and crimp the crown for snug fit; (F) Cement the crowns; (G) Cut a facial
window; (H) Trim and Smoothen the edge (I)Restoration with composite
facing.

PREVEENERED STAINLESS STEEL CROWN

• In these crowns the composite resins and
thermoplastics are bonded to the metal.
• This type of preveneered crown was
developed to serve as a convenient, durable,
reliable, and esthetic solution to the difficult
 challenge of restoring severely carious primary
incisors .

Placement of preveneered SSC

(A)Select the crown; (B) Prepare the tooth; (C) Refine the prep; (D) Trim
the crown; (E) Crimp the crown; (F) Cement the crown; (G) Cemented
crowns in place

• Various commercially available veneered SSCs

include Cheng crowns, Kinder krowns, NuSmile
and Whiter biter, pedo compu crowns and Dura
crowns.
• The drawbacks of these types of crowns are
limited crimpability as crimping of the metal
portion will weaken the esthetic facing and may
lead to premature failure; requires more
aggressive tooth reduction; the shape of the
preveneered stainless steel crowns (PVSSC) is not
alterable.
• The advantages are esthetics, full coverage,
ease to place and satisfaction for the child and
parent.

CHENG CROWNS
• Cheng crowns made their public debut in
1987.
• These are stainless steel pediatric anterior
crowns faced with a high quality composite,
mesh-based with a light cured composite. It
presents a unique solution for natural
looking stain resistant crowns.
• It is available for the right and left central
and lateral as well as cuspids. It is available
in short and regular lengths and sizes
suitable for centrals, lateral and cuspids.
• Most crown procedures can be completed
in one patient visit and with less patient
discomfort.
 • They can undergo heat sterilization
without significant effect on their bond
strength and color.
• Disadvantages of all preveneered crowns
are fracture of veneers during crimping and
they are expensive.

• Crowns can be crimped labially and lingually,

can be easily trimmed with crown scissors,
easily festooned and has got a full-knife edge
• Study has shown that these crowns with
veneer facings were significantly more retentive
than the nonveneered ones when cement and
crimping were combined.

KINDER KROWNS
• Kinder Krowns offer the most natural shades
and contour available for the pediatric patient
• The great depth and vitality from the lifelike
composite reveal a natural smile without the
bulky “Chiclet” look of other restorations.
• They come in 2 esthetically pleasing shades,
Pedo 1 and Pedo 2. The Pedo 2 shade is the
most natural shade while Pedo 1 shade is for
those cases when the bleached white shade is
wanted.
• Kinder Krowns are designed with IncisaLock—
the optimal union of state-of-the-art bonding
procedures and mechanical retention.
• By adding mechanical retention and more
composite, Kinder Krowns are strong without
sacrificing form and function.

PEDO PEARLS
• These are beautiful heavy gauge aluminum
crowns coated with US Food and Drug
Administration (FDA) food grade powder
coating and epoxy resin.
• They have universal anatomy and so can be
used on either side.
• Easy to cut and crimp, without chipping or
peeling.
• Composite can be added if required
• Disadvantages are less durability and softer
crowns.
 BONDED CROWNS
A.Polycarbonate Crowns

• Polycarbonates are aromatic linear polyesters

of carbonic acid.
• They exhibit high impact strength and rigidity
and are termed thermoplastic resins since they
are molded as solids by heat and pressure into
the desired form.
• It is esthetic than SSC, easy to trim and can be
adjusted with pliers.
• These crowns do not resist strong abrasive
forces thus leading to occasional fracture, hence
it is contraindicated in cases of severe bruxism
and deep bite.
• Advantages are that they are extremely stable
dimensionally and unaffected by acids, ether
and alcohol.
• Disadvantage is their poor abrasion resistance.
INDICATION:
• Full coverage restoration of primary maxillary
anterior teeth with extensive caries
• Early childhood caries
• Deformities in structure of teeth
• Discolored teeth.
CONTAINDICATIONS:
• Deep bite
• Bruxism
• High functionality of teeth

TECHNIQUE:
 PlaceBment of polycarbonate crowns:
(A)Following reduction of 2 mm, try the crown; (B) Trim the crown; (C) Check
for sungingival fit of crown; (D) Remove the crown for final inspection; (E)
Cement crowns; (F) Final fit of crown.

B.Modified Polycarbonate Crowns

• 3M ESPE polycarbonate prefabricated crowns
• The crowns are made of a polycarbonate resin
incorporating microglass fibers which not only
permit crown adjustment with pliers but also
give these crowns good durability and strength.
• They are a time saver as they are easy to trim
with dental burs or crown scissors, and can then
be easily adjusted with pliers
• Crown composition permits crown adjustment
• Provides good durability and strength
• Smooth surface finish for patient comfort and
to help minimize plaque build-up
• They have good anatomic form and esthetics
• They are manufactured in a universal shade
which is translucent enough to allow shade
adjustment by the type of lining material used.

STRIP CROWNS
• These are celluloid crown forms that are the
most effective for use in pediatric patients with
extensive caries in anterior teeth.
• These are commonly used crown forms filled
with composite and bonded on the tooth.
Advantages
• Easy to place and remove
• Less time consuming
• Parent/patient pleasing
• Ideal for ankylosed tooth build-ups
• Simple to fit and trim
• Removal is fast and easy
• Easily matches natural dentition
• Easy shade control with composite
TECHNIQUE:
  Strip crown placement:
(A) Carious anterior teeth should be anesthetized and properly isolated; (B)
Size of celluloid crown form is selected by measuring mesio distal diameter of
teeth; (C) Caries is removed using a small round bur in a slow speed hand-
piece; (D) Teeth are then prepared using tapered diamond or tungsten carbide
bur. Incisal, mesial and distal sides are prepared; (E) Celluloid crowns are
trimmed using curved scissors. Care should be taken not to distort the crown
form; (F) Trimmed crown forms are fitted onto prepared incisors. Length and
cervical fit should be checked ; (G) Vent holes are made in the mesial and distal
corners of the incisal edge to allow air and excess composite resin to escape;
(H) Proper shade of composite resin is chosen; (I) Composite resin is squeezed
into the crown form and hollowed in the center to reduce the excess; (J) Teeth
are etched for 1 minute with a proprietary etchant, washed and dried to get
frosty appearance; (K) Bonding agent is applied and curved for 15 seconds; (L)
A proprietary calcium hydroxide paste or glass ionomer cement is applied to
the pulpal wall of exposed dentin; (M) Excess resin is removed from the edges
which makes the final finish easier; (N) Composite resin is cured for 1 minute,
labially and palatally; (O) An excavator or probe is inserted beneath the edge of
the celluloid and the crown form is stripped off; (P) Crown forms containing
composite are firmly seated on the prepared teeth. Excess pressure should not
be applied; (Q) Smooth and polish the crowns; (R) Labial view of the finished
crown restoration

SHELL CROWNS:

• A novel technique for esthetic rehabilitation

of the maxillary anterior teeth with custom
made composite shell crowns with an indirect
approach.
• Perfection of the restoration using a silicone
positioner.
• Indirect approach so most of the work is
done on the cast thereby reducing the chair side
time.
TECHNIQUE:
 Placement of shell crowns:
(A)Clinical presentation of caries; (B) Composite build-up on cast after
excavation and impression; (C) Fabrication of Silicone positioner; (D) Shell
crowns seated in position; (E) Cementation of crown using positioner; (F)
Completely rehabilitated anterior segment with composite shell crowns

RECENT DEVELOPMENTS FOR

ANTERIOR
CROWNS IN PEDIATRIC DENTISTRY
A.PEDO JACKET:
 • It is a tooth colored copolyester material
which is filled with resin and left on tooth
after polymerization instead of being
removed.
• It does not split, stain or crack.
• Crowns can be easily trimmed with
scissors.
• Disadvantage is that only one size is
available.
B. NEW MILLENIUM

• These crowns are made up of lab enhanced

composite resin material or Zirconia.
 No long term studies are available regarding
these crowns.
C. ARTGLASS CROWNS:
• These are the only patented, preformed
crowns for pediatric usage.
• Artglass contains multifunctional
methacrylate (methacrylates with multiple
reaction sites); which has the ability to form
three dimensional molecular networks with
a highly crosslinked structure. The total filler
content of Artglass is only 75 percent (55%
microglass and 20% silica filler) but when
the matrix is cured, the amorphous, highly
cross-linked organic glass forms, which we
call polymer glass which is one of the
toughest materials available to dentistry.
• Wear of Artglass is similarto enamel and
kind to opposing
dentition.
• High inorganic filler, makes Artglass color
stable and plaque resistant.
• Matched to the Vita shade system,
simplifies shade selection.
• Flexural strength over 50 percent higher
than porcelain,less chance of fracture.
• Easily adjusted or repaired intraorally,
less chair time for dentists.
• Provides the esthetics and lasting
qualities of porcelain.
• Offers the ease and bondability of a
composite.