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: Shade A1D
3M ESPE RelyX Luting Plus 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 Plus (Adper SingleBond Plus)