Stainless Steel Crowns

STAINLESS STEEL
CROWNS

First used in the late 1940s and

became commonly used in the
1960s
Gained popularity and acceptance
along with the idea of pediatric
dentistry

Pediatric Dental Literature

The Use of Stainless Steel Crowns

Seale, NS; Pediatric Dent. 2002

Sept-Oct;24 (5):501-5

Advantages of Stainless
Steel Crowns

Can be used for badly broken down

crowns
Can be placed with poor isolation
Fast
Economical
Full coverage-prevents recurrent decay
Durable

Success of SSC Vs.

Amalgam in Primary
Molars
Combined raw data from 4 separate

studies show the failure rate for

multisurface amalgams is 26% vs. 7%
for SSCs after 5 years.
The success rate of SSCs vs. multisurface amalgams goes up dramatically
for restorations place in children under
the age of 4 years.

Randall. Pediatric Dentistry-24:5, 2002

Evidence For General

Dentistry

Longevity of Occlusally-Stressed
Restorations in Posterior Primary
Teeth

Hickel,R et al: Am J Dent 2005

Jun;18(3):198-211

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

Hickel Findings (failure

rates)

14% Stainless Steel Crowns

35.5% Amalgam
25.8% Glass Ionomer
29.1% ART (Atraumatic Rest. Tx)

*SSC failures usually failure of overall

tx i.e. tooth required extraction.

Attitudes of General
Dentists
General Dental Practitioners Views
On the Use of Stainless Steel
Crowns to Restore Primary Molars
Threlfall AG et al: Br Dent J 2005 Oct
8; 199(7):453-5.

Threlfall Study

General DDS treatment planned

clinical care for primary dentitions

Case was of a child that should

have stainless steel crowns
according to the guidelines of the
British Society of Paediatric
Dentistry.

Threlfall Study N=93

71% of the general dentists knew the

BSPD guidelines for placement of
SSCs.

Only 7% of general dentists said they

would place a SSC in this case

Only 18% had ever used an SSC in

their practice.

Reasons Given for Not

Placing Stainless Steel
Crowns

Time Consuming to Fit

Difficult to Manipulate
Expensive

Reasons Given for Not

Placing Stainless Steel
Crowns

Time Consuming to Fit

Difficult to Manipulate
Expensive
Ugly!!!!!!

Disadvantage of SSC

Time Consuming
Difficult to Manipulate
Expensive
Ugly

Stainless Steel Crowns are

Fast!!!
Most pediatric dentists can
place one in 10 minutes or
less-you can too!

Stainless Steel Crowns are

just as easy to manipulate as
a matrix band!

Stainless Steel Crowns are

Economical

You decide the fee

Best chance of one appointment
treatment.

What About Metal Allergy?

SSCs contain nickel and chromium. It is the

nickel which may elicit an allergic response
in some patients. Although more prevalent
in females, intraoral allergic responses
seem to be more minimal than extraoral
responses and also scarce.

Janson et al. Am J Orthod Dentofacial Orthop.

1998

What About Gingival

Health?

Plaque accumulation and

frequency of gingival problems
associated with SSCs in primary
teeth seem to be unexceptional
Some increased inflammation is
seen in permanent dentitions after
puberty.
Fayle. Int J Paediatr Dent. 1999

Stainless Steel Crowns

(SSC)

Indications: Primary Teeth

After pulpal therapy

SSC Indications

Following Pulp Therapy

Indications: Primary Teeth

After pulpal therapy

Multi-surface carious lesions

SSC Indications

Large, Deep Caries

Caries on 3 or more surfaces

Indications: Primary Teeth

After pulpal therapy

Multi-surface carious lesions
Proximal box extended beyond
ideal

SSC Indications

Large, Deep Caries

Caries on 3 or more surfaces

Indications: Primary Teeth

After pulpal therapy

Multi-surface carious lesions
Proximal box extended beyond
ideal
Restoration of caries in high risk
caries patients

Indications: Primary Teeth

After pulpal therapy

Multi-surface carious lesions
Proximal box extended beyond
ideal
Restoration of caries in high risk
caries patients
Teeth with extensive attrition

Indications: Primary Teeth

After pulpal therapy

Multi-surface carious lesions
Proximal box extended beyond ideal
Restoration of caries in high risk
caries patients
Teeth with extensive attrition
Behavioral Challenges

Indications: Permanent
Teeth

Interim restoration until a more

permanent restoration can be done
Financial barriers prevent gold or
PFM crown
Extensive developmental defects.
Restore occlusion and reduce
sensitivity due to enamel and
dentin dysplasia.

SSC Indications

Large, Deep Caries

Enamel Hypoplasia

1st Permanent Molars

AAPD (Amer Assoc Pediatric

Dentists)Consensus on Use of
SSCs

Children at high risk exhibiting anterior

tooth decay and/or molar caries may be
treated with SSCs to protect remaining
at-risk surfaces.
Extensive decay, large lesions or
multiple surface lesions in primary
molars should be treated with SSCs.
Strong consideration for use of SSCs in
children who require GA

Problems with White

SSCs

White facing prone to fracture and

loss
Tooth must be reduced significantly
more than conventional SSC preptherefore, pulp exposure more likely
Cannot crimp or trim as much as
conventional SSC

Stainless Steel Crown

Technique

Anatomical Differences
Primary

vs. Permanent

A.
B.
C.
D.

Enamel Thickness
Dentin Thickness
Pulpal Size
Gingival Bulge

View of Buccal Cervical

Bulge: This is what retains
an SSC

BUCCAL CERVICAL
SWEETSPOT: THIS IS THE CRITICAL
AREA FOR RETENTION

Prep (L) vs. No Prep (R):

Sweetspot Remains

SSC Technique

Proper Crown Fit: There are no crown

margins
The SSC fits over the remaining crown
and adapts with a crimped contour.

Proximal Contacts Must be

Well Broken

Ledges prevent
SSC from
telescoping over
the tooth

Rubber Dam Slit

Technique

The Sloppy Box

Technique
Stainless Steel Crown
Preparation

Cut an MOD Prep #330

Bur

Reduce Occlusal 45
Degrees 1/8 A Diamond
Bur

Lingual Cusp ReductionUse Base of MOD Prep as

Guide

1-1.5 mm Buccal
Counterbevel

Lingual Counterbevel

Round Proximal Box From

Line Angle to Line Angle

Mesial Prep
Complete/Distal Not
Complete

Note: No Gingival Seat

Ledge Remains on Mesial!

Distal Prepped: No Ledges

SSC Technique

Note: Rounded Line

Angles

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

Select SSC for Mesial-Distal

Space: Usually Rocks on From
Lingual to Buccal

Should Snap into Place Over

Cervical Bulge

Check for Open Margins

Remove With Sturdy

Instrument

Crimping To Adapt Margins

Band Contouring Plier

Note: Adapted Margins

Uncrimped vs. Crimped

Patient Bites Into

Occlusion

Confirm Occlsion

Depth Groove Technique

Depth Groove Technique

#K

Cut Occlusal Guides #330

Bur

Occlusal Depth Grooves

Connect Depth Grooves

Connecting Depth Grooves

Placing Counterbevel

Counterbevels Complete

Slicing Proximals

Prep Complete

Finishing Steps The Same