PEDIATRIC CROWNS

INTRODUCTION
 Dental decay in children’s teeth is a significant public health problem, affecting
60% to 90% of school children in industrialized countries (WHO Report 2003).

 In Scotland, the National Dental Inspection Programme (NDIP 2003) showed that
over half of 5-year old children had decayed primary teeth, with the average
number of decayed teeth in these children being five.

 Several options are available for providing full coverage restoration for the
primary dentition, with each approach having advantages and disadvantages.

 Commonly used full coverage crowns include stainless steel crowns and its
modifications, polycarbonate crowns and strip crowns.

Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue 2|March - April 2016
 With the growing awareness of the esthetic options available, there is a
greater demand for solutions to problems such as

 Nursing bottle caries

 Malformed and discolored teeth

 Hypoplastic defects

 Tooth fractures and

 Bruxism in children
  It is important to restore crowns of destroyed by early
childhood caries to preserve and promote the integrity of
primary dentition, its exfoliation and eruption of
permanent tooth.

 Numerous treatment approaches have been proposed to

address the esthetics and retention of restorations in
primary teeth.

Esthetic Crown In Paediatric Dentistry: A Review

International Journal International Journal of Innovations in Dental Sciences / August 2017 / Vol 2 / Issue 2
 Stainless steel crowns (SSC) have been used to restore primary and permanent
posterior teeth for almost 50 years.

 They are prefabricated crown forms that are adapted to individual teeth and
cemented with a biocompatible luting agent.

 SSC is extremely durable, relatively inexpensive, subject to minimal technique

sensitivity during placement, and offers the advantage of full coronal coverage.

 Despite the favourable qualities mentioned, SSCs have a major drawback—

namely, their poor aesthetic appearance.
CLASSIFICATION
 CLASSIFICATION OF CROWNS
According to Sahana S et al
 Crowns that are luted to the tooth
1) Resin veneered stainless steel crown
2) Facial cut out crown
3) Polycarbonate crowns
4) Pedo pearls
 Crowns that are bonded to the tooth
1) Strip crowns
2) Pedo jacket crowns
3) New millennium crowns
4) ART glass crowns

INTERNATIONAL JOURNAL OF CONTEMPORARY MEDICAL RESEARCH VOL 3 ISSUE 5 MAY 2016

 INDICATIONS FOR PEDIATRIC CROWNS

• Tooth with large interproximal lesions

• Tooth with hypoplastic defects
• Unaesthetic tooth due to discoloration
• Tooth that have undergone pulp therapy with significant loss of tooth structure
• Tooth with significant tooth structure loss due to trauma or caries
• Tooth with small carious lesions and with large areas of cervical discoloration

INT J DENT MED RES MAR-APR 2015 VOL 1 ISSUE 6

 1. OPEN FACED STAINLESS STEEL
CROWNS

• Introduction (year, reasercher)

• Properties
• Method of placement
• Advantages
• Disadvantages
• Studies
• Although, more durable and retentive than
• The
amalgamadventorof composite….
composite bonding,
stainless steel
allowed for a composite facing to be placed on
crowns are unaesthetic, especially on the
the facial surface of the tooth, thus improving
anterior teeth.
aesthetics.
• Open stainless steel crowns combine strength,
faced
durability and improved aesthetics.

• However, they are time consuming to place as the composite facing cannot
be placed until the stainless steel crown cement sets.
Advantages
• The are fair. (The metal shows through
aesthetics facing).
composite the
• They are very durable, wear well and retentive.
• The materials are fairly inexpensive.

Disadvantages
• The time for placement is long.

• Placement of the composite facing may be compromised

when gingival hemorrhage or moisture is present.
 Open Faced Stainless Steel Crown Technique

• Once the cement is set, cut a labial window in the cemented

crown using a no. 330 or no. 35 bur.
Extend the window:
• Just short of the incisal edge
• Gingivally to the height of the
gingival crest
• Mesio-distally to the line
angles

• Using a no. 35 bur remove the

cement to a depth of 1mm.
• Place undercuts at each margin
with a no. 35 bur or with a
no. ½ round bur
• Smooth the cut margins of the crown
with a fine green stone or white
finishing stone.
• After using a glass ionomer liner to
mask differences in color between
remaining tooth structure and
cement place a layer of bonding
agent.

• Place resin based composite into

the cut window forcing the material
into the undercuts and polymerize.

• Add additional material in 1mm

increments and polymerize.
• Finish the restoration with abrasive disks.
• Run the disks from the resin to the metal at the margins so as
not to discolor the resin with metal particles

• Repeat the procedure for the remaining teeth.

 Roberts C et al conducted the first study on resin-faced stainless steel crowns used
for restoring primary anterior teeth and described the clinical performance of these
crowns. He concluded that these stainless steel crowns have high rate of retention
and there was high prevalence of one third of the facing failure which occurred
most commonly at resin-resin and resin-metal interface.

Robert C, Lee JY, Wright JT. Clinical Evaluation Of and Parental Satisfaction With Resin-Faced Stainless Steel
Crown. Pediatr Dent. 2001;23:28-31.
 Hartmann CR and Helpin ML suggested that in children with rampant
carious lesions, open faced stainless steel crowns can be used, although
some aesthetics is sacrificed, increased functional stability is added to
these restorations

Hartmann CR. The open-faced stainless steel crowns: An esthetic technique. ASDC J. Dent. Child. 1983;50:31-3.
 PRE-VENEERED STAINLESS STEEL CROWN
 Baker LH and Waggoner WF, described that the composite resins and thermoplastics
are bonded to the metal.

 This type of pre-veneered crown was developed to serve as a convenient

durable, reliable, and esthetic solution to the difficult challenge of restoring severely
carious primary incisors.

 ADVANTAGE
 The resistance to fracture and attrition is good in preveneered stainless steel
crowns.
 The main disadvantage is the resin shades which give an artificial look.
 Placement of PVSSC is also technique sensitive as they rely on luting of the cement
and crimping of gingival margins.
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, strip and polycarbonate
crowns
• The technique does not allow for major recontouring and reshaping of the crown.
• The tooth is adjusted to fit the crown, rather than adjusting the crown to fit
the tooth.
• 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 technique.
TECHNIQUE
 Waggoner WF and Cohen H suggested that pre-veneered stainless steel
crown forms for primary incisors is an aesthetic option for the full coverage
restoration of broken down incisors

Waggoner WF, Cohen H. Failure strength of four veneered primary stainless steel crowns. Pediatr
Dent. 1995;36-40
 NUSMILE CROWNS

• They are made up of stainless steel with even more natural appearing tooth
colour coating.

• They can undergo heat sterilization without any significant effect on the bond
strength and color.

• It can withstand high load .

• These crowns are polished instead of glazed to reduce wear on opposite

dentition

Leith R, O‟Connell AC. A clinical study evaluating success of 2 commercially available pre-veneered primary
molar stainless steel crowns. Pediatr Dent 2011;33:300-6.
Advantages
• Single appointment
• Easy placement technique
• Reduces operatory time
• Less technique sensitive
Disadvantages
• More tooth preparation due to their greater bulk.
• Avoid crimping - facing susceptible to fracture, so the tooth is
prepared to fit the most appropriate crown.
• Single-use only-sterilization is recommended
NUSMILE ZR CROWNS (Anterior Teeth)

 It is made up of high grade monolith Zirconia ceramic.

 Increased durability with strength more than enamel.

 Translucency of Zirconia ceramic provides excellent esthetics and

prevents the problem of dark tooth show through pulpally treated
teeth.
NUSMILE ZR CROWNS (Anterior Teeth Technique)

• Reduce the incisal length of the tooth by approximately 2mm

and open the interproximal contacts.

• Feather-edge margin
 CHENG CROWNS
 Introduced in 1987 by Peter Cheng Orthodontic Laboratories.

 They are stainless steel pediatric anterior crowns faced with superior
quality composite mesh-based with a light cured composite.

 These crowns are natural-looking, stain resistant crowns.

Advantages:
• Completed in one patient visit (and with less patient discomfort)
• Doesn’t cause wear of opposing teeth
• Can be autoclaved
• Economic
• Less technique sensitive

Disadvantages:
• Fracture of veneers during crimping
 Anterior Crowns
•Centrals : left & right sizes (1-6)
Laterals : left & right sizes (1-6)
•Cuspids:upper& lower sizes (1-6)

•Posterior Crowns
First primary molar: upper and lower - left and right sizes (2-7) Second primary
molar :upper and lower - left and right sizes (2-7)

Baker et al conducted a study to evaluate the amount of sheer force necessary to fracture, dislodge or
deform the esthetic veneer facing of commercially available veneered primary crowns. They
concluded that Cheng crowns showed statistically significant results compared to all the other
available crowns

Baker LH, Moon P, Mourino AP. Retention of esthetic veneers on primary stainless
steel crowns. ASDC J Dent Child 1996;63:185-9.
 KINDER KROWNS

 These are composite veneer facing bonded to fenestrated SSC base

 Comes in two aesthetically pleasing shades,pedo 1 and pedo 2.

 Better mechanical retention because it is designed with an incisal lock

 Provides better retention and more space for composite, which makes it strong
without the need for sacrificing much of tooth structure.

 Kinder crowns have the most natural shades and contour existing for the
pediatric patient.

 Pedo 2 shade is the most natural shade while pedo1 is lighter bleached
shade than pedo2.

 Kinder krowns can be used in fixed bridge fabrication for replacing lost
primary central incisors.

 Zirconia kinder krowns have an internal retention system in the form of

retention bands
 Different types of crown ESSC (NuSmile) and 2 types of primary full ceramic
crowns (Kinder Krown and EZ Pedo).Kinder Krown crowns had a significantly
lower force required to fracture than the EZ Pedo and NuSmile crowns. The
force to fracture the EZ Pedo and NuSmile crowns was not significantly different
between these two.

 Vinson LA, McCrea MC, Platt JA, Sanders BJ, Jones JE, et al. (2016) Fracture Resistance
of Full Ceramic Primary Crowns. J Dent Oral Health Cosmesis
KINDER KROWNS
Manar Zaki Et Al.2007 suggested that Zirconia crowns showed the highest
fracture resistance and the NuSmile zirconia crowns were proven to resist
fracture even under intense pressure of load compared to Cheng Crowns
zirconia.
 DURA CROWNS
 They are high density polyethylene veneered crowns

 They can be crimped both on the gingival facial margin as well as the
lingual margin

 They can be easily festooned and trimmed with crown scissors

 They are available in a single shade

DISADVANTAGES
 Crimping of the metal portion will weaken the aesthetic facing and may
lead to premature failing

 These crowns require a lot of tooth reduction

 Guelman et al reported that Dura crown, Kinder krown and NuSmile
crowns were significantly more retentive when crimping and cement
were combined than that of non-veneered crowns

 Gupta et al concluded that veneer resistance to fracture for NuSmile

crimped crowns was comparable to non-crimped crowns. The crimped
crowns were associated with greater veneer surface loss
 PEDO PEARLS
• Heavy gauge aluminum crowns coated epoxy-resin.
• Serves as permanent crowns for primary teeth
• Difference is that metal used was aluminium in place of
stainless steel

ADVANTAGES:

• Universal anatomy-use on either side

• Easy to cut and crimp, without
Chipping or peeling.
• Non bulky & fits easily

Disadvantages:

• Less durability and the crowns are

Relatively soft
• Self-cured or dual-cured composite is recommended
for repairing
CROWNS BONDED TO TOOTH
 POLYCARBONATE
CROWNS
• Polycarbonate crowns are heat-
molded acrylic resin shells that are
adapted to teeth with self cured
acrylic resin.
The polycarbonate material :
i. Brittle
ii. Does not resist strong abrasive forces, exhibiting
frequent fracture and dislodgement.

• These crowns are aesthetic than stainless steel

crowns
• These crowns can be crimped because of its
flexibility
 These crowns are available in a universal colour

 They cannot resist strong abrasive forces thus leads to occasional

fractures

 Hence these crowns are contraindicated in cases of severe bruxism and

deep bite
 Polycarbonate Crowns
Technique

• Reduce the incisal edge a minimum of

2mm.

• Reduce the labial surface & lingual surface a

minimum of 2mm, finishing the preparation
subgingivally.
• For the interproximal reduction all
contact must be broken.
• Remove all remaining decay and
perform any necessary pulp tissue
treatment.

• Completed tooth preparation.

• Select a crown that fits easily over

the prepared tooth and has the
appropriate mesiodistal
dimension.
• If the crown does not seat without
incisal interference additional
tooth reduction is necessary.
• Remove the ID Tab and tab connector with a scissor
and sandpaper disc from the crown form.
• Reseat the crown form onto the
prepared tooth.
• All margins are subgingival.
• Check or estimate the occlusion.
• Adjust the margins
and occlusion.

• Remove the crown from

the tooth.

• Crimp all the gingival margins of

the crown using a bull nosed
crimping pliers.
• Simply grab the margin with the pliers and bend the margin
in. Continue around the circumference of the crown.
Cementatio
n
• Once the cement is set the occlusion is checked and adjusted.
 COMPOSITE STRIP CROWNS

• Composite strip crownsare filled

celluloid
composite crowns
forms.

• Tate, et al.2002 found that composite strip

crowns had a failure rate of 51%, compared
to an 8% failure rate of stainless steel
crowns.
Advantages
• It provides superior aesthetics.

Disadvantages
• It is extremely technique sensitive.
• It is not as durable or retentive and is not recommended on
patients with a bruxism habit or a deep bite.

• Adequate moisture control might be difficult on an

uncooperative patient.
 Composite Strip Crowns Technique

Primary celluloid crown form with a mesio-

distal incisal width equal to the tooth to be
restored by placing the incisal edge of the
crown against the incisal edge of the tooth.

• Remove decay with a medium to large

round bur on a slow speed handpiece.

• If pulp therapy is required do it at this time.

• Reduce the interproximal surfaces by 0.5
to 1.0 mm.

• The interproximal walls should be parallel and the gingival

margin should have a feather edge.

• Reduce the facial surface by 1mm and the lingual surface

by 0.5mm.
• Create a feather-edge gingival margin.
• Round all line angles.

• Trim the selected crown by removing the collar and the

gingival excess material with crown and bridge scissors.
• Place a small vent hole on the mesial distal edge surface
with a bur or explorer to allow escape of trapped air when
the composite filled crown is seated.
Fit the crown on the prepared tooth.
• The crown should extend 1mm below
the gingival margin.

• Select the appropriate shade of

composite (extra light).
• Fill the crown with resin material
approximately two thirds full.
• Etch the tooth with acid gel for 15
seconds, wash and dry the tooth, and
apply bonding agent . OR
• Use self-etching bonding
Polymerize
a agent

• Seat the filled crown form on

the tooth.
• Remove the excess material from the
vent hole and the gingiva.
• Repeat procedure with
the
adjacent teeth.the
• Polymerize the material from
both the facial and lingual directions.
• Repeat the procedure for adjacent teeth.
• Remove the celluloid form by cutting
the material on the lingual with
either a composite finishing bur or
scalpel.
• Pry the celluloid form off the tooth.

• Very little finishing is required except

for adjusting the occlusion and
smoothing gingival margins.
• Use shaped and rounded
flame finishing burs
composite for
finishing.
• Although the technique has been well described, surprisingly, very
little clinical data exists on the longevity of these crowns.
[Webber DL, Epstein NB, Wong JW, Tsamtsouris A. A method of restoring primary anterior teeth
with the aid of a celluloid crown form and composite resins. Pediatr Dent. 1979;1:244-246.
Grosso FC. Primary anterior strip crowns J Pedodont. 1987;11:182-187. Croll TP. Bonded
composite resin crowns for primary incisors: technique update. Quintessence Int. 1990;21:153-
157.]

• The procedure is very technique sensitive, and any lapses in patient

selection, moisture and hemorrhage control, tooth preparation,
adhesive application and resin composite placement can lead to
failure.

• The difficulty in application is reflected in a study that only 21% of

general dentists surveyed perform strip crowns compared to 73% of
pediatric dentists.
• [McKnight-Hanes C, Myers DR, Davis HC. Dentists’ perception of the variety of dental
services provided for children. ASDC J Dent Child. 1994;61:282-284.]
 NEW MILLENIUM CROWNS

• This is similar in form to the pedo jacketand strip crown,except

that it is lab enhanced composite resin material.

• Like others, this is also filled with resin material and bonded to the
tooth.

Advantage

• Can be finished and reshaped with a high-speed finishing bur.

• Enhanced esthetics but they are very brittle, more expensive than
other crown and cannot be crimped.
 PEDO JACKET
• It is a tooth colored copolyester material which is filled with resin and left on tooth
after polymerization instead of being removed.
ADVANTAGES:
• It does not split, stain or crack.
• Crowns can be easily trimmed with scissors.
• Thin yet strong interproximal wall allows multiple adjacent restorations with a
minimum amount of tooth reduction.
• Using a plastic primer, they can either be bonded into place with composite resin
or cemented with a glass ionomer cement.
DISADVANTAGES:
• Only one size is available
 ART GLASS CROWNS
• Multi-functional methacrylate matrix – 3 D molecular
networks with a highly cross-linked structure.

ORGANIC CROWNS.

• 75% filler (55% microglass and 20% silicafiller)

• Available in 6 sizes for every primary tooth and every Vita

shade.

• Expensive.
• Advantages
• One appointment placement
• Provide greater durability and esthetics than strip
crowns.
• Easily adjusted or repaired intraorally
• Color stable
• Wear of polymer glass similar to enamel, kind to
opposing dentition- feels natural to the patient.
Seating instructions :
• Preparation similar to S.S.C with more reduction Fits
passively
• Place artglass liquid for 1 min inside crown
• Then place flowable composite in crown and then place
on tooth
• Finish with carbide bur.
Waggoner ;Restoring primary anterior teeth Pediatric Dentistry – 24:5, 2002
Table1:Summarizes the properties and selection criteria of various full coverage
techniques currently available to practitioners.
ADVANTAGES AND DISADVANTAGES OF VARIOUS CROWNS
Biological restoration

 Collected samples of extracted teeth were thoroughly scaled, polished, freed of soft
tissues, and periodontal remnants.

 The pulp was removed from the root canal and teeth were then stored in Hanks
Balanced Salt Solution.

 Tooth which best fitted the mesiodistal, cervicoocclusal and buccolingual dimension of
the tooth to be restored was selected from the storage medium.

 Extracted tooth’s shade was also matched with the patient’s tooth.

 Selected tooth was decoronated and autoclaved at 120°C and 15 lbs for 30 min.
 Tooth to be restored was minimally prepared on all the surfaces using crown
preparation kit

 Coronal fragment of the extracted tooth was then tried for fit

 Adjustments were done until it fitted to the prepared tooth.

 .
 Tooth fragment was then cemented to the prepared tooth structure
with Glass Ionomer Luting Cement.

 Cervical regions of the restorations were polished with both rotary

instruments and resin composite polishing disks
 FIGARO CROWNS

 Figaro Crowns are the strongest ALL WHITE, METAL-FREE, BPA-FREE, pre-
formed dental crowns on the market today.
 Through extensive research and testing, data proves that Figaro Crowns
outperformed Stainless Steel Crowns (SSC) and Zirconia Crowns 2-2.5 times in
ball bearing and compression tests.
 Figaro Crowns require less tooth reduction than Zirconia crowns
 There is no need to wait for cement to set for delivery
 Fit is impeccable (Flex Fit Technology)
 Conclusion
• Many options exist to repair carious primary teeth, but there is
insufficient controlled, clinical data to suggest that one type of
restoration is superior to another.
• This does not discount the fact that dentists have been using
many of these crowns for years with much success.
• Operator preferences, esthetic demands by parents, the child’s
behavior, and moisture and hemorrhage control are all
variables which affect the decision and ultimate outcome of
whatever restorative treatment is chosen.
(Pediatr Dent. 2002;24:511-516)
References

 Steven schwarz, Full Coverage Aesthetic Restoration of Anterior Primary Teeth.

 Waggoner ;Restoring primary anterior teeth Pediatric Dentistry – 24:5, 2002

 ESTHETIC CROWNS FOR PRIMARY TEETH: A REVIEW

 Esthetic Dentistry- E-Book: A Clinical Approach to Techniques and Materials

Kenneth W. Aschheim

 Vinson LA, McCrea MC, Platt JA, Sanders BJ, Jones JE, et al. (2016) Fracture Resistance
of Full Ceramic Primary Crowns. J Dent Oral Health Cosmesis
 ESTHETIC CROWN IN PAEDIATRIC DENTISTRY: A REVIEW Dr.Veerakumar.R¹
Dr.Pavithra.J² Keerthana Sekar.G