PRESENTED BY:- Md. Irshad Shaikh ( Final Year – Part II ) GUIDED BY :- Dr. Rehan Khan

DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY

ANTERIOR CROWNS IN PEDIATRIC DENTISTRY

CONTENTS• Introduction• Indications for full coverage of

anterior teeth• Stainless crowns/open faced crowns• Polycarboxylate crowns• Composite strip crowns• Pre veneered stainless steel crowns• Zirconia crowns• conclusion

• 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.

INTRODUCTION

• 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.

CONTRAINDICATIONS

• Clinical or radiographical evidence of radicular

pathology.

• Tooth exhibits excessive mobility

• Partially erupted teeth

• Esthetically unappealing

The types of full coverage for anterior

primary teeth currently available are:• Open Faced steel crowns.

• Resin (Composite) strip crowns.

• Polycarbonate crowns.

• Pre-veneered steel crowns.

• Zirconia crowns.

Stainless Steel Crowns/Open Faced Stainless Steel

Crowns• WHAT IS A CROWN..? A Crown is a tooth shaped covering which is cemented to the tooth structure & its main function is to protect the tooth structure & retain the function.

• Stainless steel crowns were introduced to pediatric dentistry by the Rocky mountain company in 1947 and made popular by W.P.Humphrey in 1950,which proved to be boon to clinical pediatric dental practice.

• Originally it was intended for restoration of posterior primary and young permanent teeth, its use was expanded to badly decayed anterior teeth.

• Although more durable and retentive than amalgam or composite they are unaesthetic, especially on anterior teeth.

• Open faced stainless steel crowns combine strength, 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.

• The advent of composite bonding, allowed for a composite facing to be placed on facial surface of tooth, thus improving aesthetics

• Bleeding of the color of the metal margins surrounding the composite adds a grayish tinge to the tooth that is accentuated next to white enamel

Based on Morphology

Uncontoured/Untrimmed crowns

(Unitek)

Precontoured crowns (NI-chro ion crowns and Unitek)

Pretrimmed Crowns (Unitek Stainless steel

crowns, 3M, De Novo crowns

CLASSIFICATION

The advantage and disadvantages of stainless steel crowns and open faced stainless steel crowns are summarized below:-

Stainless steel crowns

Advantages

• Durability, wear well and retentive.

• The time for placement is fast.

• They may be used when gingival hemorrhage or moisture is present or when the patient exhibits less than ideal cooperation.

• They are inexpensive.

Disadvantages

• Aesthetics are extremely poor. Some parents may opt for extractions rather than restoration of the teeth.

Open Faced CrownsAdvantages

• The aesthetics are fair.(The metal shows through the composite facing.)

• Durability, wear well and retentive.• The materials are inexpensive.

Disadvantages• The time for placement is long as it involves a two step

process(Crown cementation and composite facing placement.)

• Placement of the composite facing may be compromised when gingival hemorrhage or moisture is present or when the patient exhibit less than ideal cooperation

Composite Strip Crowns• Composite strip crowns 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

• Composite strip crowns rely on dentin and enamel adhesion for retention

• They are less resistant to wear and fracture more easily.• A 2002 study by Tate et al., 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.• The cost of materials are reasonable.• The time for placement is reasonable.

Disadvantages• It is extremely technique sensitive.• It is not as durable or retentive as stainless steel/open faced

crowns, pre-veneered crowns or zirconia crowns and is not recommended on patients with a bruxism habit or deep bite.

• Adequate moisture control might be difficult on uncooperative patient.

POLYCARBONATE CROWNS

• Polycarbonate crowns are temporary crowns which can be given as fixed prosthesis to deciduous anterior teeth which will get exfoliated in future

Advantages:• Esthetically acceptable• Less chair side time• Improved retention• Flexible• Better adaptability

Disadvantages:• Breakages• Dislodgement• Discoloration

BEFORE TREATMENT

AFTER TREATMENT

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

The advantages and disadvantages of pre veneered

crowns are:-

Advantages

I. They are aesthetically pleasing

II. They require relatively short operating time.

III. They have the durability of a steel crown.

IV. They are less moisture sensitive during placement than

composite strip crowns.

Disadvantages

I. They are 3 times more expensive than stainless steel

crowns and strip crowns but less expensive than

zirconia crowns

II. These technique does not allow for major

recontouring and reshaping of the crown.

III. As crimping is limited to lingual surfaces there is not

close adaptation of crown to tooth.

IV. There are reports of the veneer facing fracturing,

however it can be easily repaired using the open

faced stainless steel crown

ZIRCONIA CROWNSZirconia (zirconium dioxide) crowns are made of solid

monolithic zirconia ceramic material.

Although discovered in 1789 by the German chemist Martin

Heinrich Klaproth, zirconia as been used as biomaterial since

the late 1960s

Its use as dental restorative material became popular in the

early 2000s with the advent of CAD-CAM technology.

Advantages• They are very aesthetic, with greater durability than

composite strip crowns and pre veneered crowns.• Biocompatibility.• They are not as technique sensitive as composite strip

crowns as the fabricated crown is cemented with self adhesive resin cement rather than bonding.

• They take a bit longer to place than stainless steel crowns and composite strip crowns, about the same as pre veneered crowns and less than open faced stainless steel crowns.

Disadvantages• They are not recommended in patients that are heavy

bruxers.• 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

REFERENCES

1. Textbook of PEDODONTICS BY SHOBHA TANDON 2nd Edition.

2. McDonalds AND AVERY’S DENTISTRY FOR THE CHILD AND

ADOLESCENTS 9th Ed,St.Louis,Mo. Mosby/Elsevier,2011.

3. Textbook of PEDIATRIC DENTISTRY 3rd EDITION – By NIKHIL

MARWAH

THANK YOU