Stainless steel crowns are widely used in Pedodontics in Dentistry.This slide is about their used ,procedure.Hope u get benifited.

1. Submitted by,
STAINLESS STEEL CROWNS
Aswanth E
P

2. Contents
Introduction
Definition
Indications & Contra indications
Classifications
Composition
Factors considered in Preoperative evaluation
Clinical procedue
SSC modifications
Complications

3. Introduction
Stainless steel crowns are prefabricated crowns
that adapted to individual tooth & cemented with
a biocompatible luting agent.
It hs many applications in pediatric dentistry.
It is indicated in case of rampant caries,recurrent
caries,after pulp therapy..

4. Definition
Prefabricated crown forms that are
adapted to individual
teeth and cemented with a biocompatible
luting agent.

5. Indications
Extensive caries
Extensive decalcification
Rampant caries
Recurrent caries:
After pulp therapy
Inherited or acquired enamel defects, e.g.
hypoplasia,
amelogenesis imperfecta (permanent and
primary teeth)
Abutment teeth to prosthesis
As part of a space maintainer

6. Contraindications
Primary molars close to exfoliation.
 Primary molars with more than half the
roots resorbed.
 Teeth that exhibit mobility.
 Teeth which are not restorable.
 Patients with known nickel allergy.

7. CLASSIFICATIONS
1)According to trimming
Untrimmed crowns
Pretrimmed crowns
Precontoured crowns

8. 2)According to composition
3)According to position
Stainless steel crowns
Nickel-chromium
crowns
Crowns for posterior
teeth, e.g. Unitek
stainless steel crowns
Crowns for anterior
teeth, e.g. NuSmile
crowns,

9. Composition of stainless steel crowns(18/8
Stainless steel are low-carbon alloy steels that
contain at least 11.5 % chromium.
Iron – 67%
Chromium – 17 to 19%
Nickel – 10 to 13%
Minor elements – 4%

10. • Crown cutting burs—pear shaped, tapering
fissure,needle shaped, smoothening burs
• Pliers—Hoe pliers, No. 114 Johnson contouring
pliers,No. 417 Crimping pliers, No. 112 Ball and Socket
pliers
• Scaler or any sharp instrument
• Crown and bridge scissors
• Crown seater and remover
• Stone and finishing burs for crown finishing
• For cementation—luting cement, glass slab, spatula
• Miscellaneous—articulating paper, wax sheet, glass
marking pencil
Armamentarium

13. Clinical Procedure
Evaluation of Preoperative Occlusion
Objective is to replicate
the existing occlusion after
the SS crown placement
Before starting the tooth
preparation we should
evaluate the occlusion by
visual examination and
transfer this relation on to
the wax sheet by asking the
patient to bite on it.

14. Crown Selection
Considerations include adequate mesiodistal
diameter, light resistance to seating, and proper
occlusal height.
A crown should be somewhat larger than the
tooth to which it is being adapted
Select the smallest crown that completely
covers the preparation and establish proper
proximal contacts

15. Can select crown via
1. Trial and error method by arbitrarily
selecting different sizes.
2. Measuring the internal mesiodistal
measurement by using a boley gauge or venire
calipers
3. By using charts
• Pick the crown with the help of sterile
tweezers or thumb forceps.

17. Height of crown should be same as that of uncut
tooth.

18. Gingival marginal contour
Smile : Buccal gingiva of 2nd
deciduous molar & lingual
gingiva of both deciduous
molars.
Stretched S : buccal & lingual
gingiva of most mandibular
deciduous 1st molars & many
maxillary 1st molars.
Frown : Due to short
occlusocervical height at
midpoint on proximal aspect
,gingiva dips on either side of
midpoint.

19. Tooth preparation
L A Given
Tooth isolated with cotton rolls,rubberdam
Remove decay with round bur
Steps in reduction
To provide sufficient space for steel crown
To remove caries
To leave sufficient tooth for retention of the crown.

20. Occlusal Reduction
 Start with pear shaped bur.
Reduce the occlusion by about 1.0 to 1.5 mm uniformly
along the cuspal structure so as to create a reduced
tooth but the same occlusal anatomy.

21. Proximal Reduction
With the help of taperingfissure and
needle burs with the main objective
of breaking the contact. Hold the bur
slightly at an angle to the long axis of
the tooth
Place wooden wedges – move bur
buccolingually – depth of slice should
be sufficient to break contact with
adjacent tooth.-feather edge finish
line.

22. Buccal/Lingual Reduction
Natural undercuts of these assists retention of SSC.
No reduction required usually.
Need to reduce the buccal bulge when it interferes
with crown seating.
Reduce and round off all line angles and sharp corners
Need a gap of 1 to 1.5 mm between the
prepared tooth and the opposing tooth during occlusion.
This is verified by asking the patient to bite on the wax
block and no marking of the prepared tooth should
be observed.
Verify the proximal cutting by passing a
thin probe onto the mesial and distal sides and feel for
ledges.
Finishing

23. Crown Attachment
To prevent any type of injury to child like accidental ingetion or
inhalation of crown due to slippage.
Soldering a hook on the lingual aspect of crown to
which floss is tied
Soldering a lingual attachment to which floss is
tied
Attachment of floss to crown structures on the
buccal aspect by special glues. This is the best
method as it provides no interference during crown
manipulation.

24. Crown Adaptation
If rubber dam is being used then it is
necessary to remove
it at this stage.
Festooning of the proximal surface
should be performed
before trying the crown as it will
facilitate in ease of
placement and will limit false
blanching signs.
Place the crown on the lingual side
and rotate it towards
the buccal side

25. Crown should fit loosely, with 2 to 3 mm excess
gingivally.
With a scaler, scratch around the gingival
margin on the crown or mark with a glass marking pencil.
Remove the crown from the prepared tooth, exposing the
scratch line. With the help of crown and bridge scissors,
cut the crown 1 mm below the scratch line

26. Check the gingival extent of crown
with the help of probe;
It should not be more than 1mm on
buccal aspect and
0.5 mm on the lingual side
2 Principles by Spedding(1984)
Crown should be of correct length & its margins should be
adapted closely to the tooth.
For shaping crown,mark points on mesiobuccal,midbuccal
and distobuccal surfaces at crest of respective marginal
gingiva without compressing the marginal gingiva.
These marks correspond to greatest diameter of tooth.
Final finished margins placed 1mm below these marks and
parallel to contours of marginal gingiva.

27. Contouring
Contouring is done with the help of No. 114 Johnson contouring pliers.
A ball and socket pliers(No. 112) is used to contour the buccal and lingual
surfaces by holding the crown firmly with the pliers and force is exerted from
the
opposite side of the crown to bend the gingival one-third
of the crown inward .

28. Crimping(inward movement )of the Crown
Poorly adapted crown will serve as
a collection point for bacteria,
contributing to recurrent
caries or incipient periodontal disease.
Using the No. 417 Crimping pliers the
crown is crimped
in the gingival third.
The procedure of crimping is that the
pliers must be
‘walked’ through the entire crown
continuously without
lifting. After completion of crimping
there will be a gradual bend in the
gingival third of crown.

29. Checking the Final Fit
Seat the crown in a lingual to
buccal direction and it
should snap into position under
firm finger pressure
After final adaptation check
for any destabilization or
rocking of crown by pressing
an explorer on the occlusal
aspect to apply load.
Critical evaluation of blanching
all around the tooth
structure must be done and a
pre-cementation radiograph
must be taken at this stage.

30. Crown Finishing
The finishing of the margins of the
crown form is done
using a green stone held at angle to the
margin.
• A slow speed handpiece will give
better and produce a
sharp featheredge margin that can be
closely adapted to
the prepared tooth at the gingival
margin.
• Crown is then smoothened with
finishing burs and
polished with rubber wheel or rouge.

31. Crown Cementation
Remove, clean and dry the crown as well as
the tooth surface. Isolate with cotton and
instruct the patient not to close the mouth.
Mix the luting cement and load onto the
crown with the help of nonsticky instruments.
At least 2/3rd of the crown must be filled with
the luting consistency of cement
Commonly used cements are zinc
phosphate,zinc oxide eugenol, reinforced zinc
oxide eugenol, polycarboxylate and glass
ionomer cements

33. Seat the crown, usually first on the lingual side & then
the buccal side at the same time supporting the child’s
mandible with one hand.
Remove excess cement with a scaler or explorer
Polishing of SSC and Discharge of Patient
Polish the crown with acidulated phosphate fluoride
prophylaxis paste prior to discharging the patient.

34. Stainless steel crown modifications
Under sized tooth or oversized
crown

35. Over sized tooth or undersized crown

36. Deep subgingival caries
Routine crown preparation
Amalgam / GIC restoration substitute to tooth structure.
Open contact
May leads to food lodging,plaque accumulation,gingivitis
Larger crown selected.
Interproximal contour exaggerated with no:112 plier or
by addition of solder interproximally.

37. COMPLICATIONS ASSOCIATED WITH SSC
Interproximal ledge
produced instead of a shoulder free interproximal slice if
the angulation of the tapered fissure bur is incorrect
May affect seating of crown.
Crown tilt
Seen if complete lingual or buccal wall is destructed by
caries or improper use of cutting instrument.
Supraeruption of the opposing tooth may occur.
Poor margins
When the crown is poorly adapted, its marginal integrity
is reduced.
Can lead to recurrent caries, plaque accumulation and
subsequent gingivitis.

38. Inhalation or ingestion of crown
Due to slippage from hand / by jerky reaction of patient
Methods of prevention are use of rubber dam, upright
seating of the patient while doing adaptation or by
soldering a hook onto the buccal surface of crown and
attaching long floss with it

39. Conclusion
Stainless steel crowns are useful for various purposes.
For the effectivness of patient ,motivation of parents &
patients cooperation are necessary.
It is not used in primary molars close to
exfoliation,tooth with extensive mobility
Procedure involve occlusal,proximal,buccolingual
reduction,adaptation,cementing..
Complications include interproximal ledge,crown tilt,poor
margins,ingestion of crown

40. Reference
1)Textbook of pediatric dentistry: Nikhil Marwah : 4th
edition
2)Pediatric dentistry : Shobha Tendon :2nd edition
3)Principles & practice of pedodontics : Arathi Rao :
2nd edition

41. Thank You