Stainless Steel Crowns are a Snap
(A Hands-on Workshop for Primary Tooth Crowns)

  I. Diagnosis
       A. Radiographic indications for crowns
        1. Very large interproximal lesions
        2. One-third or more of tooth broken down
        3. Space loss due to mesial drifting into carious areas
    B. Clinical indications for crowns
        1. Insufficient periphery into which to place a reliable restoration
        2. Broadly extended interproximal areas of coronal breakdown
        3. Space loss due to mesial drifting into carious areas
    C. Age of patient/longevity of tooth prior to exfoliation
        1. Primary anteriors are lost between 6-8 years of age
        2. First primary molars are lost between 9-11 years of age
        3. Second primary molars are lost between 11-13 years of age
        4. Complete root on primary tooth indicates at least 2 more years before loss
    D. Pulpal considerations
        1. If pulpotomy is performed, crowning is nearly always preferable
        2. If pulpectomy is performed, waiting 3-4 months prior to crowning is advisable

II. Technique
     A. Posterior stainless steel crowns
         1. Reduce occlusal surface with diamond wheel bur
         2. Remove all caries
         3. With wedges in place, complete interproximal cuts (minimal) with 169 bur or thin diamond
         4. Minimally reduce buccal and lingual surfaces, including a bevel toward the occlusal surface
         5. Round off corners to make preparation look like interior aspect of stainless steel crown itself
         6. Select crown size
              a. Should fit snugly, but still go down over tooth
              b. Check for crown length-- if tissues blanch, you will need to trim
         7. Shape crown
              a. Contouring pliers to basic curvature
              b. Crimping pliers to engage undercuts of prep
              c. With precrimped crowns, these steps are not necessary
         8. Cement crown
              a. RelyX luting cement-- excellent material
              b. ZnPO4 is OK
     B. Anterior strip crowns
          1.. Isolate with rubber dam with individually punched holes (small)
          2. Place orthodontic alasticks by stretching over teeth with two pieces of floss
              a.. Retract tissue and rubber dam
              b. Hemorrhage control
              c. Leave facial floss to facilitate removal of alastick
          3. Caries removal
              a. Slow speed round bur
              b. Vitrabond in deep areas (+increases retention)
          4. Prep incisal and axial walls
              a. Minimal occlusal and axial reduction
              b. 169 fissure bur or thin diamond bur
          5. Fit strip crown forms
              a. Must trim away entire "cuff"
              b. Crown should fit snugly
              c. Vent holes in MI and DI angles
              d. Fill 1/2-2/3 full with composite (Filtek Supreme Plus A1D shade) and condense
              e. Place over tooth
              f. Remove excess material and light
           6. Removing strip crown form
              a. Course disk to remove incisal edge
              b. Hollenbeck to "unzip" lingual
              c. Hemostat to remove strip crown
              d. Finish edges with Soflex disks
           7. Remove alasticks by pulling them up and over crowns from labial

III. Equipment and supply needs:
A.    Posterior Stainless Steel Crowns
      BURS:
      Diamond wheel for occlusal reduction
     169 fissure bur (or thin diamond) for interproximal, buccal and lingual cuts
     #6, #8 round burs for gross caries removal
     CROWNS:
     Unitek preformed stainless steel crowns (not pre-crimped)
     (Pre-crimped crowns may work on “ideal” preps)
     MATERIALS:
     Spoon (for removing crowns during fitting)
     Crown trimming scissors
     Crown countouring pliers
     Crown crimping pliers
      RelyX luting cement
     Band/crown pusher
    
B. Anterior Strip Crowns
BURS:
     169 fissure bur for all cuts—incisal, interproximal, facial, lingual
     #6, #8 round burs for gross caries removal
     CROWNS:
     3M anterior strip crown forms
     MATERIALS:
     Rubber dam
     Floss
     Orthodontic alasticks
     Etching and bonding materials
     Very light composite or compomer  (Filtek Supreme Plus A1D shade)
     Ball-burnisher (or some other condenser)
     Hollenback carver for excess material removal and cutting crown form
     3M Soflex disks (course, medium and fine)
     Needle diamond bur for finishing
     Hemostats


ACTUAL SUPPLY LIST WITH CATALOGUE NUMBERS (AS AVAILABLE):

FG169 Bur (Patterson#07-492-9683)
Diamond Wheel (Patterson #07-740-4064)
3M ESPE Sof-Lex disks (coarse/med/fine) + RA mandrel
Rubber dam clamp #8A (Patterson #07-089-2703)
Hygienic 5x5 rubber dam
Unitek orthodontic alastics #406-407
Floss (any)
Unitek Stainless Steel Crowns
3M ESPE Strip Crowns
3M ESPE Curved Crown Scissors
Rubber Dam Clamp Forceps (Patterson 07-392-3877)
Miltex Contouring Pliers (114 Johnson)
3M ESPE Crown Crimping Pliers (regular or small)
Rubber Dam Punch (Patterson #07-089-2489)
3M ESPE Filtek Supreme Ultra: Shade A1D
3M ESPE RelyX  Luting Plus Automix Cement
Finishing Bur (Patterson #7901)
1/2 Hollenback Carver
Hemostat (any)
Rubber Dam Frame (5")
2X2 Cotton Wipes (any)
Premier Sycamore wood wedges
Ball Burnisher (any)
Crown seaters (band seaters):  Unitek #811-001
Spoon Excavator (Patterson 38/39 - #092-4423)
Explorer (any)
Adhesive for Filtek Supreme Ultra  (3M ESPE Scotchbond Universal Adhesive)






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