Dental Problems

Stainless Steel Crown – Clinical Procedure

DenturesStainless steel crown procedure is a semi-permanent restoration which is used in the young and primary permanent tooth. Stainless steel crown clinical procedure is discussed briefly below in this article. Let us examine them.

Clinical procedure

  • Evaluate the preoperative occlusion:

    • a. Take the alginate impression of upper or lower arch of the patient.
    • b. Pour the cast in the dental stone.
    • c. Note the dental midline and the cusp fossa relationship bilaterally.
  • Selection of crown:

    • The correct size crown may be selected prior to the tooth preparation by the M-D dimensions of the tooth to be restored, and a Boley gauge can be used for this purpose.
    • If the crown is not selected before the tooth reduction, after the tooth reduction it can be selected as a trial and error procedure which approximates the M-D width of the crown.
    • The smallest crown that completely covers the preparation should be chosen.
    • To produce steel crown margins of similar shapes, examine the contours of the buccal and lingual marginal gingivae.
      • Buccal and lingual marginal gingivae of the second primary molar resembles smiles with greatest occlusal-gingival height of the clinical tooth crown about the midway on the buccal and lingual surfaces.
      • Buccal marginal gingivae of the most madubular first primary molar and many maxillary first molars is similar to a stretched out ‘S’, having greatest occlusal-gingival height located at the mesiobuccal.
      • The contour of the lingual marginal gingivae of all the first primary molars resembles smile.
      • The occlusal-gingival height is located about midway in bucco-lingual direction.
  • Tooth preparation:

    L.A should be administered.

    • Isolation:

      • Isolation has to be done with cotton rolls, which are held in position by cotton roll retainer.
      • Use of rubber dam for isolation is mandatory.
      • When it is not possible to use rubber dam, as in case of terminal teeth in arch, a gauze oral screen should be used to prevent the possible aspiration of a crown form.
    • Remove the decay:

      • Decay is removed with a large round bur in a slow speed handpiece or with a spoon excavator.
      • After caries removal and pulp therapy, if necessary, the previously carious areas can be built up with a quick setting reinforced ZnOE cement and/or zinc oxyphosphate cement.
    • Steps in reduction:

      The aims of tooth reduction are as follows:

      • To provide sufficient space for the steel crown.
      • To provide the caries.
      • To leave sufficient tooth for retention of the crown.
    • Occlusal reduction:

      • A 69L OR 169l bur is used to reduce the occlusal surface by 1.5 to 2.0mm, following the cuspal outline and maintaining the original contour of the cusps.
      • Reduction of occlusal surface can be judged by comparison with the marginal ridges of the adjacent teeth.
    • Proximal slices:

      • Place the wooden wedges in the interproximal embrasures.
      • The wedges separate the adjacent teeth, thus minimize the risk of damaging the tooth enamel.
      • The bur (69L or 169L) is moved B-L across the proximal surface, beginning at the marginal ridges and at an angle 910 degree) slightly convergent to occlusal surface.
      • The depth of slice should be sufficient to break contact with the adjacent tooth and it should develop a finish-line below any existing caries.
      • Preparation should be taken gingivally far enough to avoid the development of the ledge, which would make it difficult to seat the crown properly.
      • Because of cervical constriction of the primary tooth, adequate depth of the proximal preparation will result in a feather edge finish line.
    • Bucco-lingual reduction:

      • Reduction of the buccal and lingual surface is either unnecessary or very minimal. Natural undercuts of these surfaces assists the retention of the stainless steel crown.
      • However, in some cases, as the first primary molar, it is necessary to reduce the large buccal bulge.
    • Round all the line angles:

      • Using a side of the bur or diamong, the occlusobuccal and occlusolingual line angles are rounded by holding the bur at a 30-45 degree angle to the occlusal surface and moving it in a mesio-distal direction.

The above article discusses briefly about the clinical procedure of stainless steel crown.

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