Pediatric dentisry

crowns in pediatric dentistry

: Presented by
b4‫لبنى علي سامي‬
: Supervised by
Dr.wissam mohammed
 INTRODUCTION
Pediatric crowns are dental crowns used for restoring lost or damaged or decayed
teeth of children. These crowns encircle the damaged teeth completely and are made
of different materials such as ceramic, steel and more

Although advances in the application of preventive dentistry techniques, widespread

acceptance of community fluoridated watersupply and increased dental education in
parents have reduced the incidence of caries in children,but still there is high
prevalence of early childhood caries(ECC) especially in lower socio economic
population.

ECC is formely termed as 'nursing bottle caries' and baby bottle decay, the clinical
appearance of severe ECC follows a definite pattern.

There is carious involvement of the Maxillary incisors followed by Maxillary and

.Mandibular first primary molars and the Mandibular cuspids
In last half of century the emphasis on treatment of extensively decayed primary teeth
shifted from extraction to restoration.

Early restoration consisted of placement of stainless steel bands or crowns on severely

decayed teeth. While functional, they were unaesthetic and their use was limited to
posterior teeth.

Higher esthetic standard is expected by parents for restoration of their children's

carious teeth.

Thus choice of full coverage restorations for primary teeth must provide an aesthetic
appearance, function and durability
 INDICATIONS FOR FULL COVERAGE OF ANTERIOR TEETH
1. Incisors with large interproximal lesions.
2. Incisors with hypoplastic defects.
3. Unaesthetic incisors due to discoloration.
4. Incisors that have undergone pulp therapy with significant loss of tooth structure.
5. Incisors with significant tooth loss due to trauma or caries.
6. Incisors with small carious lesions and with large areas of cervical discoloration
7. In patients with infra occluded primary molars
8. Single tooth cross bite
9. Recurrent caries around existing restorations
.10. For replacing prematurely lost anterior teeth
Factor considered by dentists when choosing a crown
type are:
-durability
-esthetics
-retentiveness
-adaptability
-placement time
-allergenicity
-cost
THE TYPES OF PEDIATRIC CROWNS:
Dentists today use five main types of pediatric crowns:
•stainless steel
•composite strip
•polycarbonate
•resin-veneered
•zirconia ceramic
 Stainless steel crowns:
Stainless steel crowns have been used by dentists since the late
1940’s. The blend of iron, carbon, chromium and other metals
that make up stainless steel prevents corrosion otherwise
exacerbated by saliva. They are very durable, but do not have a
natural tooth color and are primarily used on molar teeth ,it’s
. use was expanded to badly decayed anterior teeth
 Advantages:
•Durable
•Retentive
•Low cost
•Easy to trim and contour
•Adaptable to occlusion
•Fast placement time
•Insensitive to hemorrhage or moisture

Disadvantages:
•Poor aesthetics
•Potential allergen
 open-face stainless steel crown technique:
The dissatisfying silver color of stainless steel crowns can be improved by the open-
face stainless steel crown technique.After the recommended glass ionomer cement is
set, the metal on the facial surface of the crown is removed by a 330 bur. Tooth-
colored resin is placed after etching and bonding. This open-face technique is
inexpensive and can provide a better esthetic appearance compared to the original
. silver metal color
 Composite strip crowns:
Composite strip crowns are applied using a hardening composite and a clear plastic
form or mold. Although these materials provide an aesthetic restoration, they are also
susceptible to fracture. strip crown forms must adhere to dentin and enamel, their
placement is sensitive to hemorrhage and moisture.
They are composite filled celluloid crowns forms. They have become a popular method
of restoring primary anterior teeth because they provide superior aesthetics as
compared to other forms of anterior tooth coverage.
. They are less resistant to wear and fracture more easily
 Advantage:
•Excellent aesthetics
•Moderate cost
•time of placement is reasonable

Disadvantage:
•Technique-sensitive
•Low durability
•Require adequate hemorrhage and moisture control
 Polycarbonate Crowns:
Polycarbonate crowns are temporary crowns which can be given as fixed prosthesis to
deciduous anterior teeth which will get exfoliated in future.
It Formed from acrylic or polycarbonate resin.they are most often used for temporary
restorations. Polycarbonate crowns come in one universal shade, which can be
.modified with cements and liners
 Advantages:
•Esthetically acceptable
• Less chair side time
•Improved retention
•Flexible
• Better adaptability

Disadvantages:
•Breakages
•Dislodgment
•Discoloration
 Pre-veneered Stainless Steel Crowns
Pre-veneered stainless steel crowns were introduced in the mid 1990s.

They are aesthetic, placement and cementation are not significant affected by
hemorrhage and saliva and can be placed in a single appointment

The Stainless steel crown is covered on its buccal or facial surface with a tooth colored
coating of polyester/epoxy hybrid composition.

A clinical disadvantage is they are relatively inflexible as the resin facing is brittle and
.tends to fracture when subjected to heavy forces or crimping
 Pre veneered crowns stainless steel crowns are
available which are
1. NUSMILE crowns When a full coverage restoration is needed for longevity and for
protection of remaining tooth structure

2. Cheng crowns These are crowns with a pure resin facing which make stain resistant
These crowns are pre-crimped.

3. Dura crowns These are pre veneered crowns are esthetic and can be placed with
poor moisture or hemorrhage control but they are not easy to fit and require a long
.learning curve
 Advantages:
•They are aesthetically pleasing
•They require relatively short operating time.
•They have the durability of a steel crown.
•They are less moisture sensitive during placement than composite strip crowns.

Disadvantages:
•They are 3 times more expensive than stainless steel crowns and strip crowns but
less expensive than zirconia crowns •These technique does not allow for major
recontouring and reshaping of the crown. •As crimping is limited to lingual surfaces
there is not close adaptation of crown to tooth.
•There are reports of the veneer facing fracturing, however it can be easily repaired
using the open faced stainless steel crown
 Zirconia Crowns:

Zirconia ceramic crowns are made from zirconium oxide stabilized by yttrium oxide,
thus giving them the name yttria-stabilized zirconia (YSZ). Some zirconia ceramic
crowns may contain porcelain layered within their substructure or on their outer
.surface. They are extremely strong, and typically cost more than many other crowns
 Advantages:
•Exceptional durability
•Excellent aesthetics

Disadvantages:
•High cost
•Inability to contour
•greater tooth reduction is required
 CONCLUSION
While esthetics as firmly taken root in the ever changing scenario of dentistry, it still
has a long way to go when applied to pediatrics. Ignorance amongst the parent
population and fixed mindsets as well as inability to manage children by dentists, has
contributed largely to primary anterior teeth remaining carious. It is well documented
that primary anterior teeth are important for the development of speech, guidance of
permanent teeth and for the obvious function of mastication