PEDIATRIC DENTISTRY V 37 / NO 4 JUL / AUG 15

Scientific Article IN VITRO STUDY

In Vitro Retentive Effect of Groove, Sandblasting, and Cement Type on Stainless Steel
Crowns in Primary Molars
Sidhant Pathak, MDS1 • K.K. Shashibhushan, MDS2 • K.P. Bharath, MDS3 • P. Poornima, MDS4 • V.V. Subba Reddy, MDS5

Abstract: Purpose: The purpose of this study was to evaluate and compare the effect of placing vertical grooves, sandblasting, and luting ce-
ments on the retention of stainless steel crowns (SSCs). Methods: Eighty extracted primary molars were mounted in acrylic blocks. Specimens
were divided into Group 1 (RelyX U200) and Group 2 (Smart Cem2). Teeth in each group were further subdivided into Subgroup A (no
vertical grooves and no sandblasting), Subgroup B (vertical grooves), Subgroup C (sandblasting of crowns), and Subgroup D (vertical grooves
and sandblasting of crowns). After cementation, SSCs were pulled off using a universal testing machine. One-way analysis of variance was used
for statistical analyses. Results: In Groups 1 and 2, the highest retentive strengths were found in Subgroup D (1,124 and 783 kPa, respec-
tively), followed by Subgroup C (1,066 and 748 kPa, respectively), Subgroup A (762 and 356 kPa, respectively), and Subgroup B (743 and 314 kPa,
respectively). Retentive strength in Group one was significantly higher than in Group two; Subgroups A and B were significantly lower than
C and D. Conclusions: RelyX U200 showed higher retentive strength than Smart Cem2. Sandblasting increased the retention strength, whereas
a vertical groove had no significant effect on retention. (Pediatr Dent 2015;37:XX-X) Received September 23, 2014 | Last Revision January 10,
2015 | Accepted January 10, 2015
KEYWORDS: STAINLESS STEEL CROWN, RETENTIVE STRENGTH, PRIMARY TEETH, RETENTIVE GROOVE, SANDBLASTING

It has been a challenge in dentistry to restore multisurface ca- Methods

rious lesions in primary molars with conventional restorative
materials. The introduction of stainless steel crowns (SSCs)
reduced the premature loss of teeth due to rapidly progressing
caries and improved the restoration of form and function. 1
Savide et a.l2 claimed that the best method to improve reten-
tion of SSCs is unknown. Various methods have been tried
in the past to increase the retention of SSCs.
Many modifications of tooth preparation have been done
to improve retention of SSCs. Humphrey 3 found that the
most retentive preparations had the least amount of buccal and
lingual tooth structure removed, whereas Croll1 reported that
vertical grooves enhanced crown retention by providing resist-
ance against any rotational forces during mastication. However,
the efficacy of this preparation versus a conventional prepara-
tion has not been demonstrated. Veerabadhran et al.1 found
no significant effect on crown retention after they applied sand-
blasting to the inner surface of SSCs, but the amount of
information on this technique is limited.
The choice of cementation material also plays a very im-
portant role in the retention of SSCs.4 Self-adhesive resin ce-
ments have high strength, low solubility, and easy application,
which makes them highly attractive to clinicians. 5 However,
very little information is available regarding new self-adhesive
cements and the retentive strengths they produce.6
The purpose of this study was to evaluate and compare the
effect of adding vertical grooves on the buccal surfaces of teeth
prepared for stainless steel crowns, sandblasting the inner sur-
face of SSCs, and luting with two different self-adhesive resin
cements on the retentive strength of SSCs in primary molars.
1 Dr. Pathak is a postgraduate student; Drs. 2Shashibhushan and 5Reddy are profes-
sors, 3Dr. Bharath is reader; and 4Dr. Poornima is professor and head, all in the De-
partment of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere,
Karnataka, India.
Correspond with Dr. Pathak at sidpat1@gmail.com
This investigation received approval from the Institutional Re-
view Board, College of Dental Sciences, Davangere, Karnataka,
India. Eighty extracted primary molars with sound tooth struc-
ture were mounted in cold cured acrylic resin blocks, exposing
the crowns to the cementoenamel junction.
The specimens were divided randomly into two groups:
Group one—RelyX U200 (3M ESPE, St. Paul, Minn., USA;
and Group two—Smart Cem2 cement (Dentsply Caulk, Mil-
ford, Del., USA). The teeth in each group were further sub-
divided into four subgroups: (a) control group (no vertical
grooves and no sandblasting of SSCs); (b) teeth with vertical
grooves but without sandblasting of SSCs; (c) teeth with sand-
blasting of SSCs but without vertical grooves; and (d) teeth
with vertical grooves and sandblasting of SSCs. All groups
consisted of 10 teeth each.
Conventional tooth preparation for SSCs (3M ESPE, St.
Paul, Minn., USA) was performed by a single operator. The
occlusal surfaces of all teeth were reduced uniformly by using
a straight fissure bur (no. 56). The proximal surfaces were pre-
pared with a tapered fissure bur (no. 848L) by removing all
mesial and distal undercuts without leaving any ledges. All sharp
line angles were rounded. Pretrimmed, precontoured SSCs,
previously trial fitted for proper size, were uniformly contoured
and crimped. A wire hook was soldered in the middle one-third
of the occlusal surface of all the crowns to facilitate an attach-
ment for the universal testing machine. For teeth assigned for
groove placement, the groove was prepared vertically on the
middle third of the buccal surface, with a depth of one mm and
a length of four mm, with a no. 56 carbide bur. For those teeth
for which the crowns had been assigned for sandblasting of
inner surfaces, sandblasting was done with a mixture of alum-
inium oxide and silicon dioxide particles with a particle size
of 250 µm. All teeth were cleaned with pumice and water and
dried before cementation.

RETENTIVIT Y OF GROOVE, SANDBLASTING, CEMENT 65

PEDIATRIC DENTISTRY V 37 / NO 4 JUL / AUG 15
The crowns were luted with either RelyX U200 cement
(Group 1) or Smart Cem2 cement (Group 2). Both cements
were used according to the manufacturer’s instructions at room
temperature. They were then loaded into the crown, and each
crown was seated with finger pressure. After initial set, excess
cement was removed from the crown tooth interface using an
explorer. The teeth were then stored in artificial saliva and incu-
bated at 37 degrees Celcius for 24 hours. Retentive strength
was tested using an Instron universal testing machine (H10K-S
UTM, Tinius Olsen, Noida, India). After fixing the specimens
in the machine, load was applied and gradually increased from
a zero reading to a point until the cemented crowns were com-
pletely detached from the tooth, and the corresponding value
was noted from the testing machine computer monitor. The
same procedure was followed for all the specimens. The applied
load was directly parallel to the long axis of the tooth during
crown removal with a machine crosshead speed of 0.05 inches
per minute. The retentive strength values were recorded and
calculated using the following formula:
Retentive strength = load ÷ area
The surface area was determined by flattening the crown
and marking the outer boundary of the crown’s inner surface
on a graph sheet (resembling a plus sign) and then adding
the surface areas of rectangles and squares formed within that
boundary. For retentive strength values, one-way analysis of
variance was used for multiple comparisons followed by Tukey’s
post-hoc test for group-wise comparisons, and the unpaired
t test was used for intergroup comparisons.
Results
The measured retentive strength results and the pair-wise mul-
tiple comparisons of the groups are presented in Table 1. Sig-
nificant differences were found between Group 1 (RelyX
U200) and Group 2 (Smart Cem2; P<.001), demonstrating the
significantly higher retentive strength of RelyX U200. In
Groups 1 and 2, teeth with both the vertical groove and sand-
blasting of SSCs showed the highest retentive strength values
(Subgroup D equals 1,124 and 783 kPa, respectively), followed
by teeth with sandblasting only (Subgroup C equals 1,066
and 748 kPa, respectively), the control group without any
grooves or sandblasting (Subgroup A equals 762 and 356 kPa,
respectively), and the teeth with vertical grooves only (Subgroup
B equals 743 and 314 kPa, respectively). The difference between
Table 1. COMPARISON OF RETENTIVE STRENGTH (kPa)
Subgroups Group 1 Group 2
(RelyX U200) (SmartCem2)
Minimum
A (control) 762±150 a,A 356±59 a,B 553
B (vertical
743±104 a,A 314±123 a,B 587
groove)
C (sandblast) 1066±58 b,A 748±6 b,B 1,005
D (vertical
groove + 1124±210 b,A 783±148 b,B 927
sandblast)
*Different uppercase superscript letters indicate a significant difference between groups (horizontal); different lowercase superscript letters
indicate a significant difference between subgroups (vertical). (Analysis of variance followed by Tukey’s post-hoc test, significance level=0.05.)
66 RETENTIVIT Y OF GROOVE, SANDBLASTING, CEMENT
the control group (A) and the teeth with only a vertical groove
(B) was not statistically significant (P>.05). Teeth with sand-
blasted SSCs (C) and teeth with both the vertical groove and
sandblasting of SSCs (D) were also not significantly different
(P>.05). All subgroups subjected to sandblasting (C and D)
had significantly higher retentive strength than those without
sandblasting (A and B).
Discussion
The retentive strength values of SSCs in the current study
ranged between 246 and 1417 kPa, which is substantially lower
than the 1,400 to 2,800 kPa found by Veerabadhran et al.1
This difference may be due to differences in study protocol.
In our study, grooves were placed in the middle third of
the buccal surface and were not placed proximally, because,
very often, caries destroys these surfaces in primary molars.
Results showed that SSC retention was not increased after vertical
groove placement. This finding supports the statement that
“adding grooves or boxes to the preparation with the limited
path of withdrawal does not markedly affect retention because
the surface area is not increased significantly.”7 Various previous
studies have also concluded that groove placement does not
increase the retentive strength.1,8-10 However, some authors re-
ported that cutting vertical grooves increased the surface area
and perhaps enhanced crown retention.11-3
In the current study, crowns were sandblasted with a mix-
ture of aluminium oxide and silicon dioxide particles. The
high-speed bur was avoided for lack of uniformity and fear of
perforating the crown. The airborne alumina particle-abraded
crowns were rougher, which improved mechanical interlocking
for resin cement, thereby increasing the retention.14 Various past
studies have shown that sandblasting increased the retentive
strength of cast crowns or posts or orthodontic bands.11,14-7
Contrary to this, Veerabadhran et al.1 and Worley et al.10 con-
cluded that sandblasting had no significant effect on crown
retention.
In the present study, the addition of grooves and sand-
blasting together increased the retentive strength of SSCs.
Nergiz et al.11 also obtained the same results in their study,
whereas Veerabadhran et al.1 reported no effect on the retentive
strength of SSCs, which might be due to their small sample size.
In our study, self-adhesive cements were used, which
rapidly gained popularity among clinicians due to their sim-
plified mistake-free application technique.6 RelyX U200 showed
Group 1 Group 2 Difference in retentive
strength between
Maximum Minimum Maximum Groups 1 and 2
982 246 412 406
868 160 581 429
1,191 638 804 318
1,417 635 1,134 341

better retentive strength than Smart Cem2, which could be
attributed to the micromechanical retention and chemical inter-
action between monomer acidic phosphate groups and dentin/
enamel hydroxyapatite.18 The relatively low retentive strength of
Smart Cem2, might be due to the weak chemical bonding po-
tential and high molecular weight of hydrophilic monomer
4-MET.19 Han et al.20 reported that, 48 hours after polymeri-
zation, the pH for Smart Cem2 was 4.0, which could have
adversely affected the adhesion of the mixed cement to dentin.
The results of various other studies are in accordance with the
present study.6,21-3
It is recommended that future studies possibly: (1) check
the retentive strength of SSCs before and after the use of
cement; and (2) test the mode of cement failure.
Conclusions
Based on this study’s results, the following conclusions can be
made:
1. Vertical grooves on the buccal surfaces of teeth did
not increase the retentive strength of stainless steel
crowns.
2. Sandblasting the inner surface of SSCs increased their
retentive strength.
3. Vertical grooves did not add to the retentive strength
of sandblasted crowns.
4. RelyX U200 showed significantly better retentive
strength than SmartCem2.
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RETENTIVIT Y OF GROOVE, SANDBLASTING, CEMENT 67