Post and core restoration in primary teeth

Post and core in
primary teeth

Content
POSTS
• Introduction
• History
• Rational for preservation of
primary tooth
• Changes in endodontically
treated tooth
• Treatment planning
• Basic components of post
endodontic restorations
• Definition of post and core
• Ideal properties of post
• Indications of using post in
primary teeth
• Classification of posts
• Treatment procedure
• Canal preparation for post
and core in primary teeth
• Posts used in primary teeth
• Post insertion
• Retention of post to the root
• Retention of the post to the
core
• Luting agents
• Comparative studies of post
2

• Final tooth coverage
CROWNS
• Introduction
• Importance of restoration of
destroyed crown
• Challenges in restoration of
primary anterior teeth
• Indications of full coronal
restorations
• Contraindications
• Factors to be consider
• Classifications of crowns
• Disinfection of crown
• Preparation for cementation
• Cementation of crown
• Conclusion
• References

4
Introduction
• Restoration of endodontically treated teeth has long been a
concern of dentistry.
• In 1969, black recommended using cohesive gold to restore
clinical crowns of these teeth.
• In past years, with increased effectiveness and
predictability of endodontic treatment, dentist is restoring
more pulpless teeth.
 Potashnick S, Weine F, Strauss S. Endodontic Therapy, 4th ed. St. Louis: CV
Mosby Co, 1989: 640-84.
 Goldstein GR, Rudis SI, Weintraub DE. Comparison of four techniques for the
cementation of posts. J Prosthet Dent 1986;55:209-11.

• Teeth that were once considered non restorable and extracted
are today treated endodontically and restored of function.
• Endodontic therapy enables dentist and patient with several
advantages, i.e.
– Maintenance of natural tooth and
– Restoration of esthetics and function.
5

• For a considerable period of time,
Post and core system
• Has generally been foundation restoration of choice for badly
broken teeth .
• Main purpose of post is to provide retention for a core that
– Replaces lost coronal tooth structure and
– Eventually retains permanent coronal restoration .
 Shillingburg HT, Kessler JC. Restoration of the endodontically treated tooth, 2nd
ed. Chicago: Quintessence Publishing Co. 1982:13-44.
 Ingle JI, Teel S, Wands DH. Endodontics, 4th ed. Baltimore: A Lea and Febiger.
Williams and Wilkins, 1994:877-920.
6

Historical Overview of Dental Posts and Cores
• 1728 – Pierre Fauchard described use of “TENONS” which
were metal posts screwed into roots of teeth to retain prosthesis
• 1745 – Claude Mouton published his design of a gold crown
with a gold post that was to be inserted into root.
• 1830-1870 –Wood replaced metal as material of choice for
posts.
• 1871 – Harries introduced wooden posts. However, they
swelled and caused roots fracture.
7

8
Later 19th century, single piece post crown.
•1930 – custom cast post and core replaced the piece post crowns.
•1960’s – Prefabricated post – core systems introduced
•1990’s (Shillinburg 1997) – widely used prefabricated post – core
systems.

9
In 1920, Billing and Rosenow introduced focal infection theory,
Which led to belief that nonvital teeth were etiologic agents of common
oral diseases, resulting in a rapid decline in endodontic procedures.
It took dentistry around 30 years to overcome this bias, and since that
time, many refinements have occurred in clinical post systems.
• Cast post and cores became routine methods for restoration of
endodontically treated teeth (Morgano 1999).
 Morgano S, Brackett SE. Foundation restorations in fixed prosthodontics: current
knowledge andfuture needs. J Prosthet Dent 1999;82:643–657.

Definition Of Post, Pin, & Core
• Core Buildup: The replacement of a part or the entire crown of
a tooth whose purpose is to provide a base for the retention of
an indirectly fabricated crown
• Pin: A small metal rod, cemented or driven into dentin to aid in
retention of a restoration
• Post: Rod-like component designed to be inserted into a
prepared root canal space so as to provide structural support.
This device can either be in the form of an alloy, carbon fiber or
fiberglass, and posts are usually secured with appropriate luting
agents
 American Association of Endodontists Guide to Clinical Endodontics. Available at:
http://www.aae.org/uploadedfiles/publications_and_research/member_publications/guidetocl
inendo_post.pdf (Accessed March 2, 2016)
 American Dental Association Glossary of Clinical and Administrative Terms. Available at:
http://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter#c
(Accessed February 11, 2016)
10

DENTAL PULP ANATOMY
• Idea of “Killing pulp” is to eliminate pain proprioception in
pulp chamber and root canals.
• Innervation is mainly from sensory afferents of trigeminal nerve
(fifth cranial nerve) and
• sympathetic branches from superior cervical ganglion, which
lies opposite second and third cervical vertebrae.
12

• Each bundle contains both myelinated and unmyelinated axons.
• majority of fibers are Aδ fibers,
• which are fast-conducting and range in diameter from 1 μm to 6
μm.
 Cate, A. Oral histology - development, structure, and function. 4th ed. St.Louis: Mosby;
1994, p. 204-11.
 Standring S. Gray's anatomy. 39th ed. New York: Elsevier; 2005, p. 559. 13

CHANGES IN ENDODONTICALLY
TREATED TEETH
• Endodontic repeated widely held clinical perception that
endodontic treatment weakens teeth, resulting in increased
brittleness
 While Rosen describe dentin of endodontically treated teeth as
"desiccated and inelastic,"
 Johnson et at. Additionally speculated that
Elasticity of dentin decreased with time following endodontic
treatment.
 Rosen H. Operative procedures on mutilated endodontically treated teeth. J Prosthet
Dent 1961;11:972-86.
 Johnson JK, Schwartz NL, Blackwell RT. Evaluation and restoration of
endodontically treated posterior teeth_ J Am Dent Assoc 1976;93:597-605.
14

• Purported brittleness of endodontically treated teeth has been
attributed to decreased moisture content.
• Supporting evidence for this is primarily a study by Heifer et
al. Which showed a 9% lower moisture content of pulpless
versus vital dog teeth.
 Heifer AR, Me/nick S, Schilder H. Determination of the moisture content of vital
and pulpless teeth. Oral Surg Oral Meal Oral Patho11972;34:661-70
15

• It was thought that dentin in endodontically treated teeth was more
brittle because of
– Water loss and
– Loss of collagen cross-linking .
However, more recent studies dispute this finding.
• In 1991, Huang et al. compared physical and mechanical
properties of dentin specimens from teeth with and without
endodontic treatment at different levels of hydration.
• They concluded that neither dehydration nor endodontic
treatment caused degradation of physical or mechanical
properties of dentin.
 Helfer AR, Melnick S, Schilder H. Determination of moisture content of vital and
pulpless teeth. Oral Surg Oral Med Oral Pathol 1972;34:661–70
 Huang TJ, Schilder H, Nathanson D. Effects of moisture content and endodontic
treatment on some mechanical properties of human dentin. J Endodon 1991;18:209–
15.
16

Loss of tooth structure:-
• Reduction in tooth strength is primarily due to loss of coronal
tooth structure.
• Loss of a large portion of tooth structure makes retention of
restorations problematic, and it increases likelihood of fracture.
• factors that affect choice of post and core type depend on type
of tooth and amount of remaining coronal structure.
 Sornkul E, Stannard JG. Strength of roots before and after endodontic treatment
and restoration. J Endod 1992;18(9):440-3.
17

• Nonvital endodontically treated teeth showed more resistance to
fracture than
 1-mm ferruled teeth restored with
– Cast post and core system,
– Composite resin core system, or
– Stainless steel post
– Composite resin core system.18
 Sidoli GE, King PA, Setchell DJ. An in vitro evaluation of a carbon fiberbased post
and core system. J Prosthet Dent 1997;78(1):5-9.
18

Altered physical characteristics:
Tooth structure after endodontic therapy
Irreversibly altered physical properties
Changes in collagen cross linking and dehydration of dentin
14% reduction in strength and toughness, Maxillary teeth
are stronger than mandibular teeth
19

• Combined loss of structural integrity, loss of moisture, and loss
of dentin toughness compromise endodontically treated teeth
• Special care is therefore required for restoration of pulpless
teeth.
 Christine MS, et al. Are endodontically treated teeth brittle?. Journal of
Endodontics 1992; 18(7): 332-335
20

Altered esthetic characteristics
Biochemically altered dentin modifies light refraction through
tooth and modifies its appearance
Darkening of non vital anterior teeth is a well known phenomenon
Inadequate cleaning and shaping of coronal pulp chamber also
contribute to discolouration by staining dentin from degradation of
vital tissue left in pulp horns.
21

Medicaments used in dental treatment and remnants of root canal
filling materials can also affect appearance
Endodontic treatment coupled with restorative treatment in esthetic
zone require careful control of procedures and materials to retain a
translucent natural appearance.
22

Treatment planning
It is essential to determine if tooth is restorable before endodontic treatment is
performed.
Restorative evaluation is mandatory before any definitive therapy
Successful endodontic treatment is of no value if a tooth is too extensively
damaged from caries, fracture, previous restorations, or periodontal disease to be
reliably restored.
Reliability and prognosis of a tooth should be considered before the final
treatment plan. tooth to be retained must be able to withstand functional forces
placed upon it after reconstruction
23

BASIC COMPONENTS OF POST
ENDODONTIC RESTORATIONS
• Restorations for endodontically treated teeth are
designed to:-
• Protect remaining tooth from fracture.
• Prevent reinfection of root canal system.
• Replace missing tooth structure.
 Robbins JW. Restoration of the endodontically treated tooth. Dental Clinics of
North America 2002;46:367-84.
24

– Post: Located in root and it
retains core.
– Core: Located in pulp
camber and coronal area of
tooth and it replaces missing
crown structure.
– Coronal restoration:
Protects tooth and restores
function and esthetics.
• All these components are joined
together by adhesive bonding
agents or luting cements.
CROWN
CORE
POST
25

Post
• It is a restorative dental material that is placed in root of a
structurally damaged tooth in which additional retention is
needed for core and coronal restoration.
• Main purpose of using a post is to provide retention for a
core that replaces lost coronal tooth structure and eventually
retains permanent coronal restoration.
 Trabert KC, Cooney JP. The endodontically treated tooth: Restorative concepts and
techniques. Dent Clin North Am 1984;28:923-51.
27

• Decision regarding post placement should be made based on
amount of coronal remaining tooth structure.
• Amount of remaining tooth structure is necessary to
warrant post insertion
This classification describes 5 classes, depending on number of
remaining axial cavity walls
.
 Peroz I, Blankenstein F, Lange KP, Naumann M. Restoring endodontically treated
teeth with posts and cores--a review. Quintessence Int 2005;36;737-46.
28

Class I: 4 remaining cavity walls (access cavity)
• If all axial walls of cavity remain and have a thickness
greater than 1 mm, it is not necessary to insert posts.
• In these cases, any type of definitive restoration can be
considered.
29

Classes II and III: 2 or 3 remaining cavity walls
• Class II describes loss of 1 cavity wall, commonly known as
the mesio-occlusal (MO) or disto-occlusal (DO) cavity.
• Class III represents an MOD cavity with 2 remaining cavity
walls
• Treatment in cases involving loss of 1 or 2 cavity walls does
not necessarily require insertion of a post,
• As remaining hard tissue provides enough surface for use of
other methods, in particular, for cores using adhesive
systems.
30

Class IV: 1 remaining cavity wall
• Class IV describes 1 remaining cavity wall, in most cases
buccal or oral wall
• In cases where only 1 cavity wall remains, core material has
little or no effect on fracture resistance of endodontically
treated teeth.
• Present concept suggests using posts in such cases of reduced
remaining tooth structure.
31

Class V: No remaining cavity wall
• Class V describes a decoronated tooth with no cavity wall
remaining.
• In cases of teeth with a high degree of destruction where no
cavity wall remains,
• Insertion of posts appears necessary to provide for core
material retention
32

IDEAL PROPERTY OF POST
• An ideal post and core should be resorbable but it should
provide adequate retention and resistance.
• Post should be well adapted to inner dentinal wall as it is one
of factors governing factors for retention of restoration.
• Pleasing esthetics where indicated
• High radiographic visibility.
• Bio compatibility.
33

INDICATION OF USING POST IN PRIMARY
TEETH.
• 2/3rd of tooth structure left- not indicated
• ½ crown structure lost- indicated
• At least 1 mm of tooth structure- supragingivally
• Main reason for using a post is to re-establish shape and form of
a severely decayed or fractured maxillary anterior tooth crown
while it provides support for final restoration.
• Posts also increase resistance of restored teeth to mechanical
load.
 Wanderley MT, Ferreira SLM, Rodrigues CRMD,Filho LER. Pdmary antedor tooth
restoration using posts with macroretentive elements. Quintessence Int 30:432-436, 1999.
 Guimaraes CS, Ribeiro SC, Biffi JCG, Mota AS.Comparative analysis of retention in
prefabdcated and fixed intracanal posts with differetit cement agents. RPG Rev Pos Grad
6:354-360, 1999.
34

PROBLEMS WHILE PLACEMENT OF POST
IN PRIMARY TEETH
Morphology and histology of primary teeth present a less surface
area for
 Bonding,
 Relatively large pulp chamber, and
 Aprismatic enamel which is difficult to etch
 MortadaA,King NM. A simplified technique for the restoration of severely
mutilated primary anterior teeth. J ClinPediatr Dent 2004;28:187-92.
35

• Destruction of tooth structure frequently involves
entire crown leaving just root dentine for bonding of
restorative material and thus increasing the failure rate.
 Papathanasiou AG, Curzon ME, Fairpo CG. The influence of restorative material
on the survival rate of the restorations in primary molars.Pediatr
Dent1994;16:2828.
36

1) CLASSIFICATION OF POST USED IN
PRIMARY TEETH:
1. Based on types of post space design
2. Based on material used
3. Based on post design
4. Based on fabrication
 Prashant Babaji. Crowns in Pediatric dentistry, 1sted, 2015,
Jaypee publications.
37

Based on post space design
Mushroom shaped
Tapered shaped
Onion shaped
 Prashant Babaji. Crowns in Pediatric dentistry, 1sted, 2015, Jaypee publications.
38

Based on Materials Used
 Metallic—
stainless steel, nickel-chromium, cast metal
Non metallic: –
Resin/fiber-composite post, Fiber post, glass Fiber reinforced
composite resin posts (GFRP), polyethylene fiber post, ribbon or
tapes used along with composite resin –
Ceramic
 Carbon post
Natural-biologic tooth.
 Prashant Babaji. Crowns in Pediatric dentistry, 1sted, 2015, Jaypee
publications. 39

Based on Post Design
Threaded,
Non-threaded,
Alpha,
Omega shape,
Half omega-shaped.
 Prashant Babaji. Crowns in Pediatric dentistry, 1sted, 2015, Jaypee publications.
40

Based on Fabrication
 Direct method-
Metallic,
Fiber post (readymade posts)
 Indirect method-
Resin composite post,
Custom made post
41

2) Classification on aesthetic outlook
• Cast or prefabricated metal posts have been used exclusively as
foundations for indirect restorations.
• But with emphasis on aesthetic outlook, posts and core with
composite and ceramic materials having dual function and
double taper have been introduced as alternatives.
42

Posts can be classified in a number of different
ways:
1) Depending on how retention is achieved, posts can be divided
into two main subgroups-
» Active
» Passive
2) According to its general shape,
» Parallel
» Tapered
3) By their material composition
» Composite Materials
» Ceramics7
 Geoff Bateman, Phillip Tomson Trends in Indirect Dentistry- Post and Core
Restorations Restorative Dentistry Dent Update 2005:32:190-198 43

a) ACTIVE POST:
• Mechanically engage canal walls
• Retentive in nature
• But generates stresses during their placement and
functional loading
44

b) PASSIVE POST:
• Do not mechanically engage to canal
• Less retentive in nature
• Generates less stress during their placement and
functional loading
 D.N. J.Ricketts, C.M.E.Tait , A.J.Higgins Post and core systems, refinements to
tooth preparation and cementation British Dental Journal 2005 (198) 533-541
45

a) Parallel
46

b) Tapered
47

a) Composite materials
Composite materials are composed of fibers of
» CARBON
» SILICA
• These fibers are surrounded by a matrix of polymer resin,
usually an epoxy resin.
• They also include light transmitting posts & ribbon fibre post.
48

Various types of composite materials post can
be grouped as:
Silica Fibre Post
- Aestheti Post
- Aestheti Plus
- Para Post
- Snow Post
 Mayur Hegde, Sureshchandra B Esthetic Posts - An Update J Endodontology
2012; (24):102-109.
49

Light Transmitting Post
- Double Taper Light Post
- Luscent Anchor Post
- Twin Luscent Anchor Post
Ribbon Fibre Post
- Ribbond
Based on Ceramics
- Cosmopost
 Mayur Hegde, Sureshchandra B Esthetic Posts - An Update J Endodontology 2012;
(24):102-109.
50

3) Singh SV, Chandra A. Need of a new
classification for post and core failure. Dent
Hypotheses 2015;6:141-5.
A. Classification of Cast Post:
I. According to type of alloy.
1. Gold alloy
2. Chrome-Cobalt alloy
3. Nickel-Chromium alloy
II. According to number of Post.
1. Single Post
51

2. Multiple Post
a. One Piece Post
b. Two Piece Post
» Two piece cast post
» Combination of cast post and prefabricated
post
52

B. Classification of Prefabricated Post
I. According to Taper
1. Parallel
2. Tapered
3. Parallel Tapered
II. According to surface character
1. Smooth
2. Serrated
3. Self threading
53

III. According to fit
1. Active
2. Passive
IV. According to material
1. Metallic
i) Titanium
ii) Stainless steel
iii) Brass
54

2. Non-Metallic*
i) Non-Esthetic
a. Carbon fibre post
ii) Esthetic Post
a. Polyethelene fibre
b. Glass fibre
c. Quartz
d. Ceramic
55

V. According to light transmission
1. Light transmitting
2. Non-Light transmitting
VI. According to Vent
1. With Vent
2. Without Vent
VII. According to Monoblock formation
1. Monobloc formation
2. No Monobloc formation
56

Treatment Planning
• Teeth that have been endodontically treated must be carefully
evaluated before being restored.
• Good apical seal,
• No sensitivity to pressure,
• No exudates,
• No fistula,
• No apical sensitivity,
• And no active inflammation
 Rosenstiel S, Land M, Fujimoto J, Contemporary Fixed Prosthodontics, ed 2. St.
Louis, MO:CV Mosby, 2001:255.
57

Best Time for Restoration
According to Bishop and Biggs
• Restoration immediately following completion of endodontic
therapy to protect treated tooth from microbial contamination
(Safavi 1987, Vire 1991).
• In addition, when immediate preparation of post space after
endodontic filling was compared to delayed preparation (after 24
hours), neither method proved to be consistently superior (Portell
1982).
 Bishop K. and Biggs P. Endodontic failure-A problem from top to bottom. Br Dent J 1995;
179:35-36.
 Portell F, Bernier W, Lorton L, and Peters D. The effect of immediate versus delayed dowel space
preparation on the integrity of the apical seal. J Endod 1982;8:154-160.
58

 Ideally, post space preparation is completed at
appointment when root canal is filled (Whitworth
2002).
* When a tooth had a periradicular lesion, some practitioners
– Commonly waited months for radiographic evidence of
healing prior to restoration.
– If a final restoration cannot be placed within a few weeks
of endodontic treatment.
59

• A strong, leak-resistant, protective, provisional
restoration is indicated.
A well-processed
– Temporary crown,
– Glass ionomer, or
– Acid Etched composite build-up may be considered
for minimum time possible.
 Abramovitz I, Tagger M, Tamse A, Metzger Z. The effect of immediate vs. delayed
post space preparation on the apical seal of root canal filling: a study in an
increased sensitivity –pressure driven system. J Endod 2000;26:435-439.
60

Mushroom-shaped Post Space
• Introduced by Ludd PL et
al. (1990).
• This technique is quite
unpractical approach
• Since anatomical features of
root of incisor is tapered in
apical direction.
62

• It needs removal of deep
dentin to create heal of
mushroom at wall of root
which may leads to
– Stress induction and
weakening of root.
• Inadequate fabrication of
mushroom head may result
– Inadequate retention
of crown
63

Taper-shaped Post Space
• Developed by Grosso.
It is less retentive since
 It is short.
Generate stress
concentration in root
around them as occlusal
forces are transmitted
outward in a wedge-like
fashion
64

Onion-shaped Post Space
• Developed to minimize stress
generating effect from occlusal
force.
• And derives optimal retentive
features with maximum strength
to support restoration.
• Round bur is used to create onion-
shaped bottom of post space.
65

08-03-2020 66
Treatment Procedure

EXTENSION OF POST IN
PRIMARY ROOT CANAL
67

• Innovations for short retentive posts are
needed in primary dentition due to
– Physiological resorption that occurs in primary
dentition,
– Unlike post and core used in adult dentition.
68

• Intra-canal placement is around 3mm that is cervical
one-third of canal.
• So it does not interfere with deciduous tooth root
resorption and permanent tooth eruption.
69

Local anesthesia
Rubber dam appplication
Removal of soft dentinal structure using round bur
Post of correct size is selected
70

Post space of 3mm into canal is prepared
Confirmatory radiograph is taken
Prepared post space is cleaned with saline and air dried
Acid etching of post space with 37% phosphoric acid for
15 seconds
71

Post space rinsed and air dried
Application of bonding agent
Light curing for 20 seconds
Inject flowable composite in post space
Insertion of post using cotton pliers
Light cure post
72

08-03-2020 73
Post and core (Fiber, reverse metal
and omega-shaped posts)

Modification in Post and Core Fabrications
1) Flowable composite material with fiber posts:
If flowable composite resin is used ---
• Insert it in canal space along with selected post and light
cure it.
• Then build up coronal part (core) with flowable
composite
• 3 to 4 mm above gingival margin to receive crown
74

2) Reverse metal post-insertion technique
(RMPT):
In this technique prefabricated----
• Metal screw post is inserted in root canal space in reverse
position.
• Post can be cemented in the canal with zinc phosphate cement.
• At least 3 mm of metal post left coronally for core build up with
flowable composite resin.
75

Composite post----
• Composite posts are fabricated directly by
direct method in post space using composite in
incremental layering technique.
76

Artificial teeth bonded to adjacent natural tooth---
• It involves bonding composite artificial teeth directly to
adjacent natural teeth
• It can be done by passing a fiber splint from center of strip
crown and crown along with splint loaded with composite cured
outside oral cavity then splinted to adjacent teeth with
composite.
77
Source: Jain, et al. JISPPD. 2011;4(29):327–32)]

Omega post
• Omega loop was introduced by Mortada and Kingas intracanal
retainer in year 2004.
Mortada A and King NM, “A simplified technique for the restoration of severely
mutilated primary anterior teeth,” Journal of Clinical Pediatric Dentistry, vol. 28, no. 3,
pp. 187–192, 2004.
• Total of 5 mm long post is used in primary teeth.
• Both 3mm long free ends of post is placed inside canal.
• Remaining 2 mm of omega post provides retention to coronal
restoration.
79

Advantages:
• Quick process
• Wire does not cause any internal stresses in root canal
• As it is incorporated in restorative material mainly and it can be
done with minimal chair side time.
• Coronal extension provides retention to coronal restoration
• Kumar R, Sinha A. Restoration of primary anterior teeth affected by early
childhood caries using modified omega loops - A case report. Annals of Dental,
2014; 2(4): 24-6.
80

Disadvantages:
• Adhesion between omega wire and dentinal wall is mechanical.
• Wire adaptation to internal walls is inadequate,
• Leading to dislodgement of wire, and radicular fracture due to
excessive masticatory forces.
• Hence retention of omega loop is less compared to GFRC(glass
fibre reinforced Composite).
81

HALF OMEGA POST
• Stainless steel wire is bent to half omega shaped to make post.
• Serrations are added to increase potential surface area for
attachment of restorative material
• And consequently to increase long-term stability of an esthetic
restoration.
82
0.7mm orthodontic wire was bent
with no. 130 orthodontic plier into
a half omega shape to hold the core
material
Srinivas N CH, Jayanthi M. Post Endodontic Restoration of Severely Decayed Primary
Dentition: A Challenge to Pediatric Dental Surgeon. World Journal of Dentistry,
January-March 2011; 2(1):6769.

Disadvantages
• It is direct adhesive restorative procedure which does not
always have satisfactory result because of small surface of
bonding.
• Wire do not adapt adequately to canal
Because it is not exact copy of canal which may lead to
radicular fracture as a result of excessive masticatory forces.
• Also when forcibly fitted into narrow canal, it increases internal
stress in root and may lead to fracture.
83

Rifkin in 1983 proposed a technique
• Placement of simple wire post in primary teeth .
• Which is not widely accepted because of potential for
interference with normal physiological root resorption as wire
extends long way in canal.
84

MONTHS RETENTION MARGINAL
ADAPTATION
1 MONTH 100% 100%
6 MONTHS 72% 71%
12 MONTHS 54% 15%
85
Subramaniam et al in 2008
•Carried out a study to compare efficacy of Omega shaped
stainless steel wire post and Glass fiber reinforced composite
resin.
•They found that- GFRCR intracanal posts showed better
retention and marginal adaptation than omega shaped stainless steel
wire posts.

GAMMA POST
• 0.6-mm orthodontic wire is bent to form greek letter "y".
• Loop portion is placed inside post space,
• And 2 free ends are placed toward coronal portion and help to
provide retention to coronal restoration.
86
Kumar RG, Indushekar KR. Comparison of the Retentive Strength of 3 Different Posts
in Restoring Badly Broken Primary Maxillary Incisors. J Dent Child 2010; 77: 17-24.

ALPHA POST
• Stainless steel wire is bent into Alpha shaped
• And placed in canal
• And here also extention of post in canal should not be more
than 3mm.
87
Pinheiro SL, Bönecker MJS, Duarte DA, Jmparato JCP, Oda M Bond Strength
Analysis of Intracanal Posts used in Anterior Primary Teeth: an in vitro study. J Clin
Pediatr Dent, 2006; 31(l): 32-34.

CAST METAL POSTS
• They are fabricated by using indirect method of fabrication.
They have disadvantages like
– They are expensive and require
– An additional laboratory stage for preparation of post and
– They could pose problems during natural tooth exfoliation.
• Motisuki C, Santos-Pinto L, Giro EM. Restoration of severely decayed primary
incisors using indirect composite resin restoration technique. Int J Paediatr Dent
2005;15:282-6. 15.
• McDonald RE, Avery DR. Restorative dentistry. In: McDonald RE, Avery DR, Dean
JA, editors. Dentistry for the chil and adolescent. 8th ed. St. Louis: Mosby; 2004. p.
376. 88

REVERSE METAL POST
• Short prefabricated metal post is used as reverse metal post.
• Post is inserted upside down so that 3-mm head into canal and
remaining 5 mm of threaded section was positioned out of
canal as a core for coronal restoration.
• Bevelling should be done to reduce stress concentrated at the
dentinal walls and then head of post was try-fitted with coronal
3 mm of canal.
89

Advantages
• Easy-to-perform and economical procedure with adequate
retention and good esthetic.
Disadvantages
• Possibility of cracked root subsequent to long-term function,
• Especially in children with heavy occlusion.
Eshghi A, Esfahan RK, Khoroushi M. A simple method for reconstruction of severely
damaged primary anterior teeth. Dental Research Journal, Oct 2011; 8(4): 221-25.
90

Glass Ionomer short post
• Carranza F, Garcia GF in 1999 has used Glass Ionomer
Cement directly as post in primary anterior teeth to increase
retention of coronal restoration.
Carranza F, Garcia GF: Esthetic restoration of primary incisors. Am J Dent 12: 55-
58, 1999.
91

COMPOSITE POSTS
Composite short post
• They are fabricated directly in post space by using composite
material.
• It provides satisfactory esthetics but
• Retention due to polymerization contraction & shrinkage
could be a risk.
Judd PL, Kenny DJ, Johnston DH, Yacobi R. Composite resin short-post technique for
primary anterior teeth. J Am Dent Assoc 1990;120:553-5. 92

FIBRE BASED POST
Types:
• Polyethylene fibre post
• Glass fibre post
• Glass fibre reinforced composite resin Post (GFRP)
• Carbon fibre post
Asmussen E, Peutzfeldt A, Heitmann T. Stiffness, elastic limit and strength
of newer types of endodontic posts. J Dent 1999; 27: 275-278.
93

Advantages
• High tensile strength,
• Increased fatigue resistance.
• Increased resistance to corrosion, biocompatibility to different core
materials.
• A young modulus of elasticity approaching that of dentin
Advantages of fibre post over metal post
• Esthetics
• Translucency
• Resin composite crown reinforcement
• Ease for manipulation
Gesi A, Magnolfi S, Goracci C, Ferrari M. Comparison of two techniques for removing
fiber posts. J Endod 2003; 29(9): 580-582.
94

POLYETHELENE FIBRE POSTS
They improve the impact strength.
For step wise preparation of this post
1. First removal of 2 mm of coronal portion of root filling should be
done.
2. Coronal structures and pulp chamber were etched and
conditioned properly.
3. Polyethylenefibers conditioned with bonding agent, placed in slot
of root canal, are stabilized with composite material.
4. Polyethylene fibers, 2 – 3 mm in length, are maintained above
crown to reinforce the coronal structure
95

Ribbond fibres
• These fibres have adequate translucency for cases
with great esthetic appeal
• They have advantages of easy to manipulate.
• Dual cure resin cement is used with ribbond
fibres and final restoration is done with
composite resin.
Oliveira Rocha R, Das Neves LT, Marotti NR. Wanderley MT, Pires Correa MSN.
Intracanal reinforcement fiber in pédiatrie dentistry: A case report.Quintessence
Int2004:35:263-268.
96

GLASS FIBRE POST
They are composed of unidirectional glass fibres embedded in resin
matrix.
Advantage
Stress distribution over broad surface area
Disadvantage
This post system are failure to stick to resinous matrix which
interferes with esthetics and interfere with resorption if extended
beyond 3 mm.
Mehra M, Grover R. Glassfibre post: An alternative for restoring grossly decayed
primary tooth. Int J clinPeadiat dent 2012; 5(2): 159-62
97

Glass Fiber Reinforced
• A new generation of fiber posts composed
• Of densely packed silanated E glass fibers in a light curing gel
matrix.
• Fibers are 7–10 micrometer in diameter.
It is available in different configurations, including
» Braided,
» Woven and
» Longitudinal.
• It has greater ease of handling, can be used in high stress bearing
areas and can bonded to any type of composites
98

Biologic Post and Core
• Concept of attaching natural tooth fragments began when chosak
and eidelman in1964
• ‘biological restoration’ was introduced by SANTOS & BIANCHI
in 1991,
• These are natural teeth obtained from patient or from tooth bank.
• If it is not acceptable by many patients.
• It is easy to perform and economical.
• It has some of disadvantages like
– Need of tooth bank, donor and recipient acceptance and
cross-infection make this treatment option largely
impractical
99

Regarding primary teeth,
Tavares et al were first authors to describe a case in which tooth
fragments were used to restore carious primary posterior teeth.
• Conventionally, this technique consists of bonding sterile dental
fragments to teeth with large coronal destruction.
Ramires-Romitoet al (2000),
used teeth from Human Tooth Bank of Sao Paulo University Dental
School to be used as natural posts and crowns to fit into roots and
replace crowns as well.
Santos J, Bianchi J. Restoration Of Severely Damaged Teeth With Resin Bonding
Systems. Quintessence Int 1991; 22: 611-5.
King A, Setchell D. An In Vitro Evaluation Of A Prototype Cfrc Prefabricated Post
Developed For The Restoration Of Pulpless Teeth. J Oral Rehabil 17: 599-609, 1990.
100

Post Luting agent Suggested by
Ni- Cr post with
macroretentive
element
Dual cure resin Wanderley MT (1999)
Gamma post
Flowable composite
Kumar R Gajjar (2010)
Half omega post Shrinivasan CH (2011)
GlassFibre
Reinforced
Composite post
Yusuf K (2011)
Glass fibre post Mehra M (2012)
Omega (Metal post) Glass ionomer cement Ganesh R et al (2012)
Reverse metal post Zinc phosphate
cement
Eshghi A, Esfahan RK, Khoroushi M
(2011, 2014) 101
LUTING AGENTS
• Selection of luting agents mainly depends on type and material of
post being used.

Subramaniam P, Babu Grish Kl, Sunny Raju. Glass Fiber
Reinforced Composite Resin As An Intracanal Post- A Clinical
Study. J Clin Pediat Dent 2008;32(3):207-210.
• Priya Subramaniam et al, compared Fiberglass post with
Omega shaped stainless steel wire in primary maxillary
anterior teeth.
Results
• After one year, they found fiberglass post showed better
retention and marginal adaptation than omega shaped stainless
steel wire.
103

GLASS FIBRE REINFORCED COMPOSITE POST
V/s OMEGA WIRE V/s COMPOSITE POSTS :
Gujjar et al, Journal of Dentistry for Children,
2010 -
Results
Glass fiber posts showed greater dislodging strength,
followed by orthodontic "γ" wire posts and, least of all,
composite posts.
104

BIOLOGICAL RESTORATIONS V/s OMEGA WIRE
POSTS
Grewal N and Seth in 2008
Concluded that
• Biologic restoration presented as a cost effective,
clinical friendly, less technique sensitive and esthetic
alternative to commercially available restorative
materials used for restoring deciduous teeth affected by
early childhood caries
105
GREWAL N, SETH R. COMPARATIVE IN VIVO EVALUATION OF RESTORING SEVERELY
MUTILATED PRIMARY ANTERIOR TEETH WITH BIOLOGICAL POST AND CROWN
PREPARATION AND REINFORCED COMPOSITE RESTORATION. JISPPD 2008 (DEC):141-
148.

GLASS FIBRE REINFORCED COMPOSITE POSTS V/s
OMEGA WIRE EXTENSION POSTS
Sainil et al, 2011 -
• High cost of glass fiber reinforced composite resin post limits
its use.
• Considering socioeconomic status of patient, a custom-made
post using an orthodontic wire followed by strip crowns was
used.
• It is technique sensitive and requires parent's and child’s
cooperation.
• Also, there is a chance of loss of restoration due to trauma or
biting on hard food, so parents were instructed to teach child to
avoid hard food.
106

Author/
year
sample groups Evaluatio
n criteria
results conclusion
Judd PL
et al
1990
N = 92
teeth
Short
composit
e post
with
composit
e resin
crown
Marginal
integrity,
mobility,
caries at
the
composite
resin—
tooth
margin and
fractures at
6 and 12
months
Four teeth in two
patients showed
recurrent caries at
the composite
resin-tooth cervical
margin. Three of
these teeth were
restored and one
was extracted.
Three crowns
showed incisal
fracture of minimal
severity. These
were later rebuilt
with a resin add on
technique. Four
crowns displayed
severe attrition in
one patient who
was a severe
bruxer.
Short posts were
retentive.
Recurrent caries
and severe
bruxism—factors
beyond operator
control—posed
some problems
that were readily
resolved.

Author/
year
n criteria
results conclusion
Sharaf
AA 2002
N = 12
Age = 4
years
N = 30
teeth
Fiber
glass
post with
celluloid
strip
crown
Color
match,
marginal
adaptation,
marginal
discoloration
, anatomic
form,
secondary
caries,
gingival
condition,
pain,
temperature
sensitivity
and
periapical
condition at
3, 6, 9 and
12 months
28/30 teeth
performed well.
Failure in pulp
treatment rather
than failure of the
restoration itself
was reported in
2/30 teeth.
This technique
significantly
improved the
fracture load
resistance of
composite
celluloid crown.

Author/
year
n criteria
results conclusion
Mortada
A, King
NM
2004
N = 25
Age =
38
months
N = 96
teeth
Omega-
shaped
wire post
with
compom
er
Retention,
recurrent
caries and
the
presence
of any
periapical
radiolucen
cy at 3, 6,
12 and 18
months
In two patients
although the
restorations were
intact, the
endodontic
procedure was
considered to have
failed.
By the 18-month
recall, 81.2% teeth
were available for
examination and of
these there was
complete retention
of the restorations
on 79.9% of the
teeth
The technique for
restoring primary
anterior teeth
was simple, quick
and effective.

Author/
year
n criteria
results conclusion
Grewal
N, Seth
R 2008
N = 32
Age =
3-5
years
Group 1
(n = 75):
Biologic
post and
crown
Group 2
(n = 75):
short
composit
e post
Modified
USPHS
system
applied
every 0, 3,
6, 9 and 12
months
Clinical
performance of
biological post and
crown restorations
and intracanal
reinforced
composite
restorations was
comparable with
respect to shade
match, marginal
discoloration,
marginal integrity,
surface finish,
gingival health,
retention, and
recurrent carious
lesions.
The biological
restoration
presented as a
cost-effective,
clinician-friendly,
less-technique
sensitive and
esthetic
alternative to
commercially
available
restorative
materials used
for restoring
grossly carious
deciduous teeth.

Author/
year
n criteria
results conclusion
Subram
aniam P
et al
2008
N = 10
Age =
3-4
years
Group 1
(n = 14):
Fiber
glass
post with
celluloid
strip
crowns
Group 2
(n = 14):
Omega-
wire post
with
celluloid
strip
crowns
Retention
and
marginal
adaptation
at 1, 6 and
12 months
Fiber glass posts
showed better
retention and
marginal adaptation
than omega-shaped
stainless steel wire
posts.
Glass fiber posts
show better
retention and
marginal
adaptation than
omega-shaped
stainless steel
wire posts.

Author/
year
n criteria
results conclusion
Aminab
adi NA,
Farahan
i RM
2009
N = 60
Age =
3-4
years
N = 144
teeth
Omega-
shaped
wire post
with
compom
er
Retention,
recurrent
caries and
the
presence
of any
periapical
radiolucen
cy at 6, 12
and 24
months
The failure rates
after 12 and 24
months were 10.8%
and 18.5%
respectively. The
primary canines
exhibited minimum
loss of the
restorative material.
Two teeth exhibited
pathological
mobility after 2
years. There were
not any signs of
root fracture or
recurrent caries in
any of the restored
teeth.
The modified
omega loop is an
efficient
technique. The
ease of
manipulation and
short chairside
time are further
advan-tages of
the technique.

Author/
year
sample groups Evaluation
criteria
results conclusion
Memarp
our M,
Shafiei F
2013
N = 24
Mean
age =
4.2
years
N = 55
teeth
Polyethyl
ene
ribbon
fibers
followed
by
composit
e resin
Modified
Ryge
criteria
every 6
months for
30 months
The surface textures
for most of the
restorations were
judged as excellent.
There was no
evidence of
significant changes
in marginal integrity.
Most restored
incisors (81%)
received an Alpha
rating for retention.
The baseline and
recall retention
scores differed
significantly (p =
0.002)
Polyethylene fiber
posts along with
extensive
composite
restorations
showed excellent
clinical
performance.

• A crown is a restoration that covers a tooth to restore it to
normal shape and size. ( S.G. Damle, 2000)
• A crown is necessary when tooth is totally broken down and
merely fillings cannot restore the tooth to its normal structure
and function.
• Over the past eighty years, crowns for primary teeth have
undergone generational advancements, including design,
materials, and cement formulations.

• Improvements in material science along with innovations in
manufacturing processes and dental materials have provided
 A variety of dental crowns available, fabricated from different
materials that allow for a more esthetic restoration.
Elqadir AJ, Shapira J, Ziskind K, Ram D. Esthetic restorations of primary anterior
teeth. Refuat Hapeh Vehashinayim (1993). 2013 Apr; 30(2): 54-60,82

IMPORTANCE OF RESTORING
PRIMARY TEETH
• Apart from a compromised in esthetics, dental destruction may also
lead to development of
a) Parafunctional habits like tongue thrusting,
b) Speech problems,
c) Psychological problems,
d) Neuromuscular imbalance with reduced masticatory efficiency
e) Loss of vertical dimension of occlusion
• Karthik V, John C, Sandhya K; Polycarbonate crowns for primary teeth revisited:
Restorative options, technique and case reports; Journal of Indian Society of
Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |
• Mathew R; Esthetics in primary teeth; Int Res. J. Pharm, 2013, 4(8)

f) Self- esteem
g) Maintenance of arch length
• Usha M, Deepak V, Venkat S, Gargi M; Treatment of severely mutilated
incisors: a challenge to the pedodontist. J Indian Soc Pedod Prev Dent 2007;25
Suppl:S34-6.
• Attari N, Robert JF. Restoration of primary teeth with crowns-a systemic review
of the literature.Eur Arch Pediatr Dent. 2006 Jan;7(2):58-62.

CHALLENGES IN RESTORATION OF
PRIMARY ANTERIOR TEETH
1. Small size of teeth
2. Close proximity of pulp to tooth surface,
3. Relatively thin enamel and surface area for bonding,
4. Issues related to child behaviour
5. Finally cost of treatment.
• Shah PV, Lee JY, Wright JT. Clinical success and parental satisfaction with
anterior preveneered primary stainless steel crowns. Pediatr Dent 2004;26:391-
5.

INDICATIONS OF FULL CORONAL
RESTORATIONS
• Large/multi surface caries or lesion.
• Interproximal caries extending beyond line
angles.
• Following pulpotomy or pulpectomy
• High caries risk children.
• fractured tooth which has lost most of tooth
structure
Vivek K, Kayal G, Arun S, Sanjeev R, Saravana K; Modern Concepts In Esthetic
Rehabilitation Of Primary Anterior Teeth In Pediatric Dentistry; JINDENT; 2014; vol 4 (2)

• child’s behaviour makes moisture control difficult in placing
class III restorations
• In a teeth where a direct restoration is likely to fail
• Teeth with extensive wear
• Waggoner WF. Restoring primary anterior teeth: Review. Pediatr Dent
2002;24:511- 6.
• Nash DA. The nickel- chromium crown for restoring posterior primary teeth.
JADA; 1981; 102: 44-49
• Fayle SA. UK national guidelines in paediatric dentistry. Int J Paediatr Dent.
1999; 9: 311-314

• Patient of bruxisim
• Cervical decalcification
• Developmental defect of multiple hypoplastic defects
• Use as an abutment for space maintainer.
• Discolored teeth that are esthetically unpleasing
S Sahana, A K Vasa, R. Sekhar; Esthetic Crowns For Primary Teeth: A Review;
Annals And Essences Of Dentistry; Vol. - Ii Issue 2 April – June 2010

CONTRAINDICATIONS
• Contraindications include:
a) Primary posterior teeth in which conservative amalgam
restorations can be placed.
b) Teeth expected to exfoliate within a brief period of 6 to 12
months
c) Clinical or radiographical evidence of radicular pathology.
d) Tooth exhibits excessive mobility
e) Partially erupted teeth

FACTORS TO BE CONSIDER
• Factors to be considered when choosing a crown type are:
1. Durability
2. Esthetics
3. Retentiveness
4. Adaptability
5. Placement time
6. Allergenicity
7. Cost

CLASSIFICATION
Classification
Acc. to
material
used
Acc to
location
Acc to form
and contour
Acc to
Sahana S
et al

1. According to materials used:
a. Stainless steel crown
b. Polycarbonate crown
c. Zirconia crown
d. Composite strip crown

2. According to location:
a. Crown for anterior teeth
b. Crown for posterior teeth
3. According to form and contour:
a. untrimmed, uncontoured and uncrimped crowns
b. Precontoured and untrimmed crowns

4. According to Sahana S et al:
a) Crown that are luted to tooth:
i) Resin veneered stainless steel crown
Ii) Facial cut out crown
Iii) Polycarbonate crown
iv) Pedo pearls

b) Crowns that are bonded to tooth:
i) Strip crowns
ii) Pedo jacket crowns
iii) New millennium crowns
iv) ART glass crowns
Sahana S, Vasa AAK, Sk Ravichandra. Esthetic Crowns For Anterior Teeth: A
Review. Annals and Essence of Dentistry. 2010-2:87-93.

Stainless Steel Crown
 INTRODUCTION:
• Preformed metal crowns for primary molar teeth were first
described in 1950 by Engel followed by Humphrey
• Engel RJ. Chrome steel as used in children’s dentistry. Chron Omaha Dist Dent Soc.
1950; 13: 255-258
• Humphrey WP. Use of chrome steel in children’s dentistry. Dental survey. 1950:26:
945-258

COMPOSITION:
– 17-19% chromium
– 10-13% nickel
– 67% iron
– 4% minor elements
• Chromium contributes to formation of a very thin surface film
that protects against corrosive attack.

• There are 3 classes of stainless steel,
i) Martensitic Types,
Ii) Ferritic Types,
Iii) Austenitic Types - Best Corrosion Resistance

 Nickel Chromium
• It is primarily nickel-chromium alloy.
• COMPOSITION 76% nickel,
15% chromium,
8% iron,
0.08% carbon, and traces of other elements.

 INDICATIONS:
1. Extensive decay in primary and young
permanent teeth.
2. Following the pulp therapy

3.For teeth with hypoplastic defect
4. developmental defects or anomalies such a
enamel dysplasia or dentinogenesis imperfecta.

5. Extensive abrasions like bruxism
6. As an abutment, For a space maintainer or
prosthetic appliance.

7. For correcting developing anterior cross bite
8. Interim restoration of fractured tooth.
Subramaniam P, Kondae S, Gupta KK: Retentive strength of luting cements for
stainless steel crowns: an in vitro study. Journal of Clinical Pediatric Dentistry 2010,
34:309-12.

 CONTRAINDICATIONS:
• Primary posterior teeth, in which conservative amalgam,
restorations can be placed.
• Teeth to be exfoliated within a brief period of 6 to 12 months.
• In a patient with a known nickel allergy or sensitivity

 ADVANTAGES:
• These crowns are more superior to multisurface amalgam
restoration with respect to life span, replacement , retention and
resistance.
• They are acceptable to both patient and dentist
• They are more cost effective
Randall BC; preformed metal crowns for primary and permanent molar teeth: revie of
literature; Pediatric Dent; 2002;24; 489-500

• Easy to place
• Fracture proof
• Wear resistant
• Attaches firmly to tooth until exfoliation
• The technique sensitivity or the risk of making errors during their
application is low.
• Restoration of choice in children with high- risk for caries.
Seale NS. The use of stainless steel crowns. Pediatric Dent. 2002; 24; 501-5

 DISADVANTAGES:
• The aesthetics is not fair
• Cannot be used when the tooth is only partially erupted
Venika G, Anup P, Jolly S, Priyanka Pl; CROWNS IN PEDIATRIC DENTISTRY: A
REVIEW; Journal of Advanced Medical and Dental Sciences Research |Vol. 4|Issue
2|March - April 2016

 DIFFERENT TYPES OF STAINLESS STEEL CROWN:
1) Untrimmed - These crowns are neither trimmed nor contoured
thus require lot of adaptation and are time consuming.
Eg :- Rocky Mountain.
a- untrimmed
b- precrimped
c- pretrimmed

2) Pretrimmed - These crowns have straight non-contoured
sides but are festooned to line parallel to the gingival crest.
They still require contouring and trimming.
Eg : - Unitek Stainless steel Crowns and 3M Co.
3) Precontoured - These crowns are festooned and are also
precontoured though a minimal amount of festooning and
trimming may be necessary.
Eg : - Unitek Stainless steel Crowns and 3M Co.

 CHARACTERS OF CROWN:
• Heating does not increase their strength.
• They work harden and strength increases from manipulation
e.g. with pliers.
• Their high chromium content reduces corrosion.
• Soldering with flux reduces their corrosion resistance.

OBJECTIVES
– To achieve biologically compatible masticatory component and
clinically acceptable restoration.
– To maintain the form and function of tooth and where possible,
the vitality of the tooth should be maintained.

• upper and lower dental arch impressions with alginate are
made.
• Pour the cast with the dental stone.
• With the help of an instrument e.g. probe
check cusp fossa relationship bilaterally
 EVALUATE THE PREOPERATIVE OCCLUSION:

 SELECTION OF CROWN:
• The correct size crown may be selected
prior to the tooth preparation by the M-D
and occuso-gingival dimensions of the tooth
to be restored.
• A Boley gauge can be used for this purpose.

• Local anesthesia is administered
• Rubber dam placed.
• Wedges are placed inter-proximally.

 REDUCTION OF TOOTH:
The aims of the tooth reduction are:
• To provide sufficient space for the steel crown.
• To remove the caries.
• To have sufficient tooth structure for retention of the crown.

• Occlusal reduction
Occlusal reduction of 1 to 1.5mm

• Proximal reduction:
Preparation of mesial and distal surfaces
done with no. 169 L bur.
• Contact must be completely opened.
• Avoid damaging the adjacent tooth

• Buccal & lingual reduction
• Minimal reduction needed
• In cases as 1st primary molar
necessary to reduce large buccal bulge
• It is done by using side of bur

• Occlusal reduction for primary molars suggested by
various authors
08-03-2020 156
Sr.no Researcher Year Occlusal reduction
in mm
1 Humphrey 1950 Cups should be
reduced if
necessary
2 Mink and
Bennet
1968 1–1.5 mm uniform
reduction
3 Mathewson
et al.
1974 1–1.5 mm
4 Troutman
and Kennedy
1976 1.5–2 mm
5 Rapp 1966 Preparation height
4 mm from gingival
margin

 Final steps in preparation:
• Bevelling the cusps
• Roundening of all the line angles.

 INITIAL ADAPTATION OF CROWN:
• Now the selected crown is placed on the tooth.
• Crown should snap fit loosely onto the
tooth , with 2-3mm excess gingivally.

Different crown adapting equipment
Pliers name Nomenclature of pliers Use of pliers
Johnson contouring plier no 114 Contouring occlusal and
middle third of crown
Gordon plier no 137 Contouring gingival third
of crown
08-03-2020 159
Crimping plier no 800-417 Marked gingival crimping
Ball and socket plier no 112 Exaggerating
interproximal contour in
open
contacts , for bell-shaped
contouring
Howe plier no 110 Flattening interproximal
contour of crown
Crown and bridge
scissor
Cutting excess material
at gingival third of crown

Reynold plier Contouring
Curved Howe no. 111 Proximal contouring of
crown
08-03-2020 160

08-03-2020 161
List of pliers for crown adaptation (from left to
right—Reynold, Gordon, ball and socket,
Jonson,crimping, straight Howe, curved Howe

• For shaping the crown margins mark 3 light
points on the metal at the (mesiolingual,
lingual and distolingual)and at (mesiobuccal,
buccal, distobuccal) surfaces at the crest of
respective marginal gingiva without
compressing the marginal gingiva.

• Final finished margins are placed approximately 1mm below
these marks.
• Try the crown again and check for gingival blanching.

 SEATING THE CROWN
• Now crown is tried on the preparation by
seating the lingual first and applying
pressure in a buccal direction so that the
crown slides over the buccal surface into
the gingival sulcus.
• Resistance should be felt as the crown slips
over the buccal bulge.

 CROWN CONTOURING:
• Initial crown contouring is performed with a114 plier (ball and
socket plier) in the middle 1/3rd of the crown to produce belling
effect
• This will give the crown more even curvature

Crown contouring can be done with following
pliers:
Contouring pliers
• # 114 ball and socket pliers
• # 137 Gordon pliers
• # 800–114 Johnson pliers
Crown crimping
• • Crimping pliers No. 800417
08-03-2020 166

 CROWN CRIMPING:
• This is very important for gingival Health of
supporting tissue.
• Using no.417 crimping pliers crown is crimped in
gingival third.
• After completion of crimping there
will be gradual bend in the gingival
third of crown.
• use of crimping is for
protection of soft Tissues.

 CHECKING FINAL ADAPTATION OF THE CROWN
• Crown must snap into place, should not be able to be removed
with finger pressure.
• The crown should fit so tightly that there is no rocking on the
tooth.
• Moderate occlusal displacement forces at the margin should
not displace the crown.

• The properly seated crown will correspond to the marginal
height of the adjacent tooth and is not rotated on the tooth.
• Crown is in proper occlusion and should not interface with the
eruption of teeth.
• There should be no high points
• The crown margin should extend about 1mm beneath the
gingiva.

• No opening should exists between crown and tooth at the
cervical margins.
• Crown margins closely adapted to tooth and should not cause
gingival irritation.
• crown should seat without cutting or blanching the gingiva.

 FINISHING AND POLISHING:
• Accumulation of plaque and inflammation of gingiva is
commonly seen in practice of restorative dentistry due to
rough and unpolished restoration.
• To avoid these complications crown should be polished prior
to cementation with rubber wheel to remove all scratches.

 RADIOGRAPHIC CONFIRMATION OF THE
GINGIVAL FIT

 STEPS FOR CEMENTATION OF CROWN
• Stainless steel crown should be cemented
only on clean, dry tooth.
• Isolation of teeth with cotton rolls is
recommended.
• Rinse and dry the crown inside and outside and
prepare to cement it.

• Seat the crown completely on dried tooth surface
preparation.
• Final placement should follow an established path of
insertion of the crown.
• Mix luting cement and fill the crown
• A zinc phosphate, zinc oxide eugenol, reinforced zinc
oxide eugenol, polycarboxylate or GIC is preferred.
• Cement should be expressed around all margins.

• Before the cement sets, ask the patient to close into centric
occlusion by applying pressure through a cotton roll
and confirm that the occlusion has not been altered.

• Excess cement should be removed at this
stage with explorer tip or waxed floss in
the interproximal aspect.
• Rinse the oral cavity and before
dismissing the patient, re-examine the
occlusion and the soft tissue.

 SPECIAL CONSIDERATIONS:
• Adjacent stainless steel crowns….
• Stainless steel crown and adjacent class II amalgam restoration…..
• Adjacent stainless steel crowns
With Arch Length Loss….

 ADJACENT STAINLESS STEEL CROWN:
• Nash 1983, described additional reduction of adjacent proximal
surfaces of teeth when adjacent are to be restored with Stainless
steel crowns simultaneously.
• When more than one stainless steel crown needs to be done in a
quadrant then one crown is finished and cemented before
proceeding to next one because if both are prepared at one time it
might lead to encroachment of space for either one of them.
• Hartmann CR. The open face stainless steel crown: an esthetic technique. J Dent Child
. 1983; 50 (1); 31-3

 STAINLESS STEEL CROWN AND ADJACENT CLASS II
AMALGAM RESTORATION:
• When a stainless steel crown and a class II amalgam restoration are
to be done at one appointment then the crown is finished first and
then the restoration is done.
• After the crown is cemented, clean the excess cement from and
around the crown.

• Adapt and wedge a matrix band
• Now insert an amalgam restoration
• stainless steel crown is used as a guide in reproducing the anatomy
and morphology of the silver amalgam restoration.

 ADJACENT STAINLESS STEEL CROWN WITH ARCH
LENGTH LOSS:
• Extensive and long standing carious lesions can cause a shift
of primary teeth into the interproximal contact areas.
• With this mesiodistal dimension loss, it is very difficult to
restore the lost arch length.

• Myers 1976, suggested modifications of SS crowns:
• more than usual reduction in the tooth to be crowned can be
done so as to enable the crown to fit into the available
mesiodistal space.
• McEvoy 1977, recommended additional tooth reductions in
space lost quadrants.
• Myers DR. the restoration of primary molars with stainless steel crown. J Dent
Child. 1976; 43(6); 406-9
• McEvoy SA. Approximating stainless steel crown in space loss quadrants. J Dent
Child; 1977; 44(2): 105-7

 STAINLESS STEEL CROWN MODIFICATIONS:
In 1971, Mink & Hill report several way of modifying the
stainless steel crown when they are either too large or too small
• Undersize tooth or the oversize crown.
• Oversize tooth or undersize crown.
• Deep subgingival caries.
• Mink HR, Hill CJ. Modifications of stainless steel crown for primary teeth. J
Dent Child. 1971; 38(3):197-205

Try the crown on the tooth
Use a pair of scissors to cut the crown from the gingival to the
occlusal surface, either buccally or lingually
Pinch the crown together, in effect reducing the crown size
Again try the crown on the tooth. The gingival margins of
the crown should approximate the gingival margins of the
tooth

The cut edges can then be repositioned and spot
welded
Polish the soldered areas
Check the crown for marginal adaptation, contour,
crimp, and cement the crown

2. Oversized tooth or the undersized crown:
Check the crown on the tooth
Cut a V- shaped groove in the crown on the buccal or
lingual side
Try the crown on the tooth for fit

Spot- weld a strip of orthodontic band material over the
V- shaped groove in the crown
Polish the soldered area and cement the crown
Solder, adapt, contour, and crimp the crown
Retry the crown on the tooth

3. Deep sub gingival caries:
Prepare the crown for tooth
Cut a piece of orthodontic band conforming to the
lesion
Spot- weld the piece to crown and check the
adaptation extent
Solder and polish the area and cement the crown

 COMPLICATIONS
• Interproximal ledge
• Crown tilt
• Poor margins
• Ingestion of crown

1. Interproximal ledge:
• A ledge will be produced instead of shoulder free
interproximal slice if the angulation of the tapered fissure bur
is incorrect.
• Failure to remove this ledge will result in dufficulty in seating
the crown.

2. Crown tilt:
• This is seen if complete lingual or buccal wall is destructed by
caries
• Or improper use of cutting instrument
• disadvantage of this is that supra erruption of the opposing
tooth may occur.

3. Poor margins:
• When the crown is poorly adapted, its margins integrity is
reduced.
• this can lead to recurrent caries, plaque accumulation,
subsequent gingivitis

4. Inhalation or ingestion of crown:
• May happen because of slippage from hand or jerky reaction
of patient
• Preventions can be taken as:
 Use of rubber dam
 Upright sitting the patient while doing adaptation
 By soldering the hook on buccal surface of crown and
attaching long floss to it

• If this occurs, attempt can be made to remove the crown by
holding the child upside down as soon as possible
• If this is unsuccessful, medical referral should be done for an
immediate chest x-ray to verify if the crown is in lungs or in
alimentary tract.

Modifications of
stainless steel crown

Open Faced Stainless Steel Crown
• This is a simple variant of the normal stainless steel crown
where after cementation a labial fenestration is created.
• The success of open-face stainless steel crown is caused by:
1. Firmly bonding resin to teeth tissue
2. Using dentin bonding
3. Phosphoric acid etching.
A rough and porous structure may be formed on the remaining
glass ionomer cement.
Unfilled resin may infiltrate into this irregular
and hard surface, form holding tags, and, thus,
contribute to bonding.

• Advantages:
• Economical
• Easy to use
• Well adapted to tooth
• Esthetically pleasing
Sahana, Suzan; Kumar Vasa, Aron Arun; Sekhar, K. Ravichandra; Vijaya Prasad,
K. E. Esthetic crowns for primary teeth: a review. Annals & Essences of
Dentistry.2010; 2 (2): 87-93.

• Disadvantages
1. The procedure is time consuming.
2. Metal margins can still be seen.
3. Clinicians have to contend with hemorrhage control during
application of composite facings.
4. May have a short lifespan
5. May have poor color stability under oral conditions
Sahana, Suzan; Kumar Vasa, Aron Arun; Sekhar, K. Ravichandra; Vijaya Prasad, K. E.
Esthetic crowns for primary teeth: a review. Annals & Essences of Dentistry.2010; 2 (2):
87-93.

Technique:
• Once the cement is set, cut a labial window in
the cemented crown using a no. 330 or no. 35
bur.
• Extend the window:
 Just short of the incisal edge.
 Gingivally to the height of the gingival crest.
 Mesio-distally to the line angles.

• Smooth the cut margins of the crown with a
fine green stone or white finishing stone.
• use a glass ionomer liner to mask
differences in color between remaining
tooth structure and cement
• place a layer of bonding agent.

• Place resin based composite into the cut
window forcing the material into the undercuts
and polymerize
• Add additional material in 1mm increments and
polymerize.
• Finish the restoration with abrasive disks.
• Run the disks from the resin to the metal at the
margins so as not to discolor the resin with
metal particles.

• Yilmaz et al. in 2004 compared the clinical success of stainless
steel crowns (SSCs) made esthetic by open facing or veneering
on posterior primary teeth.
• Thirty-three crowns (18 open-face and 15 veneered) were
placed and followed up for 18 months with semiannual
evaluations.
• This study showed that open-face SSCs had a higher but not
significantly different success rate than veneered SSCs.
• Upper arch crowns exhibited a higher success rate than those
in the lower arch.

PREVENEERED STAINLESS STEEL
CROWNS
• These crowns offer a potential esthetic and durable restoration
for grossly decayed primary teeth, as these crowns allegedly
combine the durability of conventional SSC with the esthetic
appeal of composite resin.
• are available with a variety of facing materials such as
composite resin or thermoplastic resin bonded to the stainless
steel crown.
• Esthetic veneers are retained on the stainless steel crowns
using a variety of mechanical and chemical bonding
approaches
• Venika G, Anup P, Jolly S, Priyanka P; CROWNS IN PEDIATRIC
DENTISTRY: A REVIEW; Journal of Advanced Medical and Dental Sciences
Research |Vol. 4|Issue 2|March - April 2016

• These crowns are available for both posterior and anterior
primary teeth
• This has been described in the literature for the restoration of
deciduous teeth.1
• Innes NP, et al. Preformed crowns for decayed primary molar teeth. Cochrane
Database Syst Rev. 2015 Dec 31; (12).

• Placement technique:
Tooth preparation is as for a standard stainless
steel crown; however more circumferential tooth
reduction is required
This crown only allows crimping of the metal
lingual margin of the crown; therefore, it is
necessary to refine the prep to fit the crown
Do not force the crown on the tooth.
A properly fitted crown has a passive fit.

The crown should extend 1 mm past the gingival
margin.
The length of the crown is altered by trimming the
gingival margin with a diamond bur and water
spray.
The lingual aspect of the crown may be crimped
slightly with a 137 Gordon plier.
Too much crimping of the metal substructure may
cause fractures in the veneer material.

The crown is cemented with glass ionomer cement.
The excess cement is removed and the occlusion is
checked. Only minimal occlusal reduction is allowed,
as the veneer will weaken

• ADVANTAGES
1. Aesthetically pleasing result is obtained with relatively short
operative time.
2. Durability
3. They give good results in conditions where moisture control is
difficult.
4. Less sensitive to hemorrhage

LIMITATIONS
• They are 3 times more expensive than stainless steel,
• The addition of resin creates a SSC with an increased
thickness compared to a conventional SSC, and therefore more
extensive tooth preparation is required to allow for proper fit
and occlusion.
• dentist has no choice on the resin shade, and the supplied
crowns are sometimes so white that they look artificial in the
mouth.

• Difficulty in placing multiple approximating crowns in patients
with crowding or space loss due to bulk.
• Crown forms that are tried in, but do not fit, cannot be sterilized
under pressure with high heat, because such treatment will destroy
the attached resin layer.
YILMAZ Y, GULER C., Evaluation of different sterilization and disinfection methods on
commercially made preformed crowns; J Indian Soc Pedod Prevent Dent - December
2008

• Resin facing material is relatively inflexible and brittle that tends
to break when subjected to heavy force.
• The labial section of the margin cannot be crimped, because the
bonded resin material will detach. The uncrimped region,
therefore, does not fit as precisely as does a non veneered steel
crown.
• Randall RC: Preformed metal crowns for primary and permanent molar teeth: review
of the literature. Pediatric Dentistry 2002, 24:489-500.

• Two techniques may be used to replace the veneer on the crown.
• One technique is similar to the technique for fabricating the open-
faced, stainless steel crown.
• Yilmaz Y, Gurbuz T, Eyuboglu O et al. the repair of preveenerd posterior stainless
steel crowns. Pediatr Dent. 2008 Sep- Oct; 30(5); 429-35
• Kratunova E, O’ Connell AC. Chairside repair of preveenered primary molar stainless
steel crowns; a pilot study. Pediatr Dent. 2015 Jan-Feb; 37(1); 46-50

• An alternative technique is sandblasting/roughening the labial
and occlusal surfaces of the existing stainless steel crowns with
an abrasive powder or diamond stone, application of a bonding
agent and a composite.
• Both repair techniques showed similar results in appearance
and longevity
• O’ Connell AC, Kratunova E, Leith R. Posterior Preveenered stainless steel crowns; clinical
performance after three years. Pediatr Dent. 2014; May- Jun; 36(3); 254-8
• Krantunova E, O’ Connell AC. A randomized clinical trial investigating the performance of
two commercially available posterior pediatric preveenered stainles steel crowns; a
continuation study. Pediatr Dent. 2014 Nov- Dec; 36(7); 497-8

Biological approach or Hall technique for
placement of stainless steel crowns:
• Preformed metal crowns have been used for restoring primary
molars since the 1950s.
• Hall Technique is named after Dr. Norna Hall, a dentist working
in Scotland, who has developed a simplified technique where the
crown is simply cemented over the carious primary molar, with
no local anaesthesia, caries removal, or tooth preparation of any
kind.
• Innes NPT, Stirrups DR, Evans DJP, Hall N. A Novel Technique Using Preformed
Metal Crowns for Managing Carious Primary Molars in General Practice – a
retrospective analysis Brit Dent J 2006; 200(8):451-4

 Advantages:
• Quick and noninvasive
• No tooth preparation is needed
• No need for caries removal
• No need for local anesthesia and rubber dam
• Acceptable to dentist, parent and child

 Disadvantages:
• Untreated caries may cause pulp pathologies
• Difficulty in retreatment
• It is a supplement to conventional technique but not a
substitute

 Indications:
• Class I- noncavitated lesion where in the child is unable to
accept fissure sealant
• Class I- cavitated lesion where in the child is unable to accept
caries removal or conventional restoration.
• Class II- cavitated or noncaviated lesions.

 Contraindications:
• Signs or symptoms of irreversible pulpitis
• Clinical or radiographic signs of pulp exposure
• Unrestorable crowns.
• Patient at risk for bacterial endocarditis

 Technique:
• The placement of seperators is mandatory
• The six stages of crown placement are:
1. Size: the smallest crown that covers all the
surfaces is selected.
2. Fill: dry the crown and fill with glass ionomer
cement
3. Locate and seat: seat the crown by using finger
pressure and ask the child to bite on it

4. Wipe: excess cement has to be wiped off
with a cotton wool roll.
5. Seat further: ask the child to bite on the
crown firmly for 2-3
minutes.
6. Clean: Remove excess cement by means
of scaler and floss the
contacts.

Polycarbonate Crowns
• These are prefabricated shells formed from acrylic
or polycarbonate resin and was described by Miller
in 1973
• Once cured and trimmed, the polycarbonate crown is
cemented to the prepared tooth.
• they are available in variety of sizes but come in one
universal shade which can be modified with cements
and liners1
• Lan Shuman; Pediatric crowns; from stainless steel to zirconia;
www.Dental AcademyORCE.com

Indications:
• Stewart RE et al (1974) summarised various indications as:
1. Rampant caries involving three surfaces of the tooth.
2. After pulp therapy
3. Tooth malformation
4. Abutment for space maintainers

Contraindications
1. When there is inadequate spacing between teeth.
2. Crowding of anterior
3. Deep impinging bite is present
4. Severe bruxism
5. When there is evidence of abrasion in the anterior teeth.

• Placement technique:
Crown preparation first on mesiodistally followed by incisal reduction
Margins should be feather edge
A trial fit is carried out to check for proper fit, marginal adaptability, overall
coverage, occlusal interference, and mesiodistal width
Necessary adjacement to polycarbonate crown if required ( either with a crown
cutting scissors or a trimming stone)

After the final fit is done, the crown is relined using a self-cure acrylic resin (The
advantage of this type of relining technique is that the resin chemically bonds to the
polycarbonate crowns.)
By priming the inside of the relined crown, it can be bonded to the tooth using composite
resin or glass ionomer cement.
After the complete set of the reline material, the margins are trimmed and finished and the
crown is cemented using a luting cement or composite resin.

ADVANTAGES
1. Improved esthetics
2. Extreme dimensional stability
3. They are unaffected by dilute mineral and organic acids, ether
and alcohol.
4. Less chair side Time
5. Improved retention
6. They are flexible1
Karthik V, John C, Sandhya K; Polycarbonate crowns for primary teeth revisited:
Restorative options, technique and case reports; Journal of Indian Society of
Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |

DISADVANTAGES
1. Poor abrasion resistance.
2. Breakage
3. Discoloration
4. Crown is frequently dislodged if the tooth is heavily destroyed and
retention form is inadequate.

• Various methods have been suggested for improving adhesion.
• A study by Wiggin et al (1978) evaluated tensile strength
relative to preparation design using retentive grooves.
• Result showed that retention was increased by type of cement
used instead of grooves.
• Tsamtsouris et al in1977 verified this.
• Wiggins CE, Caputo AA, Jedrychowski JR. an investigation of bonding systems
for the polycarbonate crown restoration. J Am Dent Assoc. 1978 May; 96(5);
823-6
• Tsamtsouris A, White GE, Ficarelli J. An improved method to cement
polycarbonate crowns on deciduous anterior teeth. Quintessence Int Dent Dig.
1977 Feb; 8(2); 47-50

COMPOSITE STRIP CROWN
• Also known as Celluloid crown forms
• These are transparent, hollow, plastic crowns that
are filled with composite resin and placed over
the prepared tooth.
• Excess resin is removed, and the composite resin
bulk is cured through the clear crown matrix.
• Once fully cured, the form is stripped away from
the composite resin leaving a directly bonded
composite crown

Advantages:
Kupietzky A et al (2002) stated following advantages of strip
crowns:
i. They are simple to fit and trim.
ii. The removal is fast and easy.
iii. Easily matches natural dentition.

iv. They leave smooth shiny surface.
v. They have easy shade control with composite.
vi. They are superior esthetically, functionally and economically.
vii. They are crystal clear and thin.
viii. They are easy to repair.
• Kupietzky A Bonded Resin Composite Strip Crowns For Primary Incisors:
Clinical Tips For Successful Outcome. Pediatr Dent. 2002;24:145-8.

Disadvantages:
Ram D et al (2003)
• most technique sensitive option,
• moisture contamination with blood or saliva interferes with the
bond and
• haemorrhage can alter shade or colour of material.
• Ram D, Fuks AB, Eidelman E, et al. Long-Term Clinical Performance of Esthetic
Primary Molar Crowns. Pediatr Dent. 2003;25:582-4.

• Techniques:
Earlier technique was mentioned by Webber et al (1979),
• Select a primary celluloid crown form
• a mesio-distal incisal width should be equal to the tooth to be
restored by placing the incisal edge of the crown against the
incisal edge of the tooth.

• Removal of decay with a medium to large round bur on a slow
speed handpiece.
• If pulp therapy is required should be done at this time.

• Reduction of interproximal surfaces by 0.5 to 1.0mm.
• The interproximal walls should be parallel and the gingival
margin should have a feather edge.
• Reduction of the facial surface by 1mm and the lingual surface
by 0.5mm.
• Create a feather-edge gingival margin
• Round all line angles.

• Trimming of selected crown by removing collar and gingival
excess material
• Place a small vent hole on the lingual surface with a bur or
explorer to allow escape of trapped air when the composite
filled crown is seated

• Fit the crown on the prepared tooth.
• crown should extend 1mm below
gingival margin.
• Maxillary lateral incisors are usually 0.5
to 1.0mm shorter than central incisors.
• Select the appropriate shade of
composite (extra light).
• Fill the crown with resin material
approximately two thirds full.

• Ethch tooth with etchant
• Apply bonding agent
• Polymerize
• Seat the filled crown form on
the tooth.
• Remove the excess material
from the vent hole and the
gingiva.
• Polymerize the material from
both the facial and lingual
direction

• Remove celluloid form by cutting the
material on the lingual with either a
composite finishing bur or scalpel.
• Cut celluloid form off tooth.

• Very little finishing is required except for
adjusting the occlusion and smoothing
gingival margins.
• flame shaped and rounded composite
finishing burs for finishing can be used

• Another technique was described by Eden and Taviloglu
(2016)
• A Composite resin core is build up in successively cured
layers.
• Final layer is created using composite resin and strip crown
form.

• This prevents uncured resin that may occur using a bulk-fill
technique
• Also avoids excessive shrinkage and the stresses
• But, are susceptible to fracture
• Because the hardening composite inside composite strip crown
forms must adhere to dentin and enamel

Zirconia Crowns
Introduction:
• Zirconia (zirconium dioxide) crowns are made of solid
monolithic zirconia ceramic material.
• Although discovered in 1789 by the German chemist Martin
Heinrich Klaproth, zirconia has been used as a biomaterial
since the late 1960s.
• Its use as a dental restorative material became popular in the
early 2000s with the advent of CAD-CAM technology.
• In the later part of the decade they became available as
preformed crowns for primary teeth

Advantages:
• They are very aesthetic, with greater durability than composite
strip crowns and pre-veneered crowns.
• They are not as technique sensitive as composite strip crowns
as the fabricated crown is cemented with self-adhesive resin
cement rather than bonding
Disadvantages
• They are not recommended in patients that are heavy bruxers.
• Greater tooth reduction is required.

Technique:
Select the correct crown size by placing the
incisal edge of the crown against the incisal edge
of the tooth
Reduce the incisal edge 1 – 1.5mm.

• Reduce labial surface a minimum of 0.5- 1.0 of
tooth structure in three planes (gingival-middle-
incisal thirds).
• These three planes extend from 1-2mm
subgingivally all the way to the middle of the
incisal edge of the prep

• Reduce the lingual surface by removing 0.75-
1.25mm of tooth structure from the lingual surface,
• It should extend 1-2mm subgingivally to the middle
of the incisal edge of the preparartion following the
natural contours of the existing clinical crown.
• Check the occlusion to insure there is adequate
clearance from opposing dentition.

• The red arrows mark the most common areas
of internal interference that, if under-prepared,
will make it difficult to seat zirconia crowns.
• Lingual and facial reductions should meet at a
thin incisal edge of the final restoration.
• This thin incisal edge helps to reduce internal
interferences between the tooth and the internal
surface of the crown.

• Completed tooth preparation.
• The circumference of the overall prep should
be ovoid when viewed from the incisal edge.
• Facial and lingual surfaces should not be prepared flat, but
rather curved interproximally.
• Removing extra material in these areas will insure an easier fit
with less internal interference and allow mesial/ distal rotation
for a better alignment of the crown during final cementation.

Ceramic crown adjustment.
• It is possible to adjust a pedo ceramic crown.
• it is necessary to use a high speed, fine diamond with lots of
waters because excessive heat could cause fractures in the
crown’s ceramic structure.
• Occlusal and interproximal adjustments are not recommended,
as these will remove the crown’s glaze and possibly create a
weak area of thin ceramic.

Passive fit.
• It is very important that zirconia pedo crowns fit passively.
• Because, zirconia do not flex, pushing harder will not work.
• no attempt to force a crown to fit.
• Excessive pressure may fracture the crown.
• The appropriate size crown should fit passively and
completely subgingivally without distorting the gingival tissue.

Recent Advances
1. PEDO JACKET:
• These crowns are made of tooth colored
copolyester material which is filled with a
composite resin and then cemented on to
prepared tooth surface.
• Only difference between strip crown
and this is that this crown is retained, not
removed.

Advantages:
• Crown placement can be completed in a single sitting
• Cost effective
• Multiple adjacent restorations with minimal tooth reduction
• Crown will not split, stain or crack
• Can be trimmed with scissors

Disadvantages:
• Available in a single color so shade selection is difficult
• Cannot be reduced by using high speed finishing bur

2. Cheng crowns:
• Cheng crowns were introduced in 1987 by Peter
Cheng Orthodontic Laboratories
• They are stainless steel pediatric anterior crowns
faced with a superior quality composite,
meshbased with a light cured composite.
• Prashant Babaji. Crowns in Pediatric Dentistry. 1st edition.
Jaypee Publishers. 2015.

Advantages:
• Natural looking
• They are simpler to place
• less patient discomfort
• Plaque resistant
• Color stable
• Stain resistant
• Minimal wear to the opposing tooth

Disadvantages:
• They fracture easily on crimping
• Are expensive

• Baker et al conducted a study to evaluate the amount of sheer
force necessary to fracture, dislodge or deform the esthetic
veneer facing of commercially available veneered primary
crowns.
• They concluded that Cheng crowns showed statistically
significant results compared to all the other available crowns.
• Baker LH, Moon P, Mourino AP. Retention of esthetic veneers on primary
stainless steel crown. ASDC J Dent for Children.1996;63(3):185-9

3. Kinder crowns:
• They have many minute depressions called incisal Locks.
• This increases their surface area thus provides better bonding
and retention.
• They are available in 2 shades i.e Pedo 1 and Pedo 2.
• Pedo 2 shade is the most natural shade.
• While Pedo 1 shade is for those cases where bleached white
tooth color is required.

Advantages:
1. Reveal a natural smile without bulky ‘chiclet’ look
2. have the most natural shades and contour existing for the
pediatric patient.
3. IncisaLock provides better retention and more space for
composite, which makes it strong without the need for
sacrificing much of tooth structure.

Disadvantages:
1. Staning
2. Wear of crown venner
3. Veneer have thinner facing
occlusopalatally. This area is more prone
to fracture.
4. Buccal cusp is more prominent. This area
shows a typical pattern of metal exposure.
5. Proximally, sharper angulation is present,
causing sometimes a small metal exposure
at mesial contact area.

4. Pedo pearl
• Are heavy guage aluminium crowns coated with a epoxy resin.
• These crowns can be crimped easily as compared to other
crowns
• Have universal anatomy so can be used on either side
• When the epoxy resin coating wears off at the contact point
with the opposing tooth, it can be patched up with more
composite.

Disadvantage: Yilmaz (2009)
1. Less durability
2. Crowns are soft
3. Likewise in areas of heavy occlusion, there is usually wearing
off of white coating

5. Glastech crowns:
• Artglass is a polymer glass which provides a
natural feel, bond ability associated with
composite but esthetics and longevity of
porcelain.
• It is a bifunctional and multifunctional
methacrylates which forms a three dimensional
molecular network with highly cross-linked
structure.
• Due to such structural nature of the crown they
are also known as “organic crowns”.
• It consists of 55% microglass and 20% silica fille

Benefits of the crown
• Esthetics same as natural dentition
• Durable
• Wear is similar to enamel
• Inorganic filler particles provide color stability and make them
plaque resistant
• Flexural strength is over 50% higher than porcelain
• Can be easily adjusted or repaired intraorally
• Ease and bondablitiy of a composite.
• Requires minimum chairside work

6. Dura crowns:
•Dura crowns are high density polyethylene veneered
crowns.
•These crowns are available in a single shade.
Advantages:
1.They can be crimped both on the gingival facial
margin as well as the lingual margin
2.They can be easily festooned and easily trimmed with
crown scissors.
3. It has got a full-knife edge.

Disadvantages:
1. Crimping of the metal portion will weaken the aesthetic facing
and may lead to premature failure
2. Crown should be as much as close fit possible in order to
reduce the need for crimping and to minimize the dependence
on the strength of the cement.
3. Requires a lot of tooth reduction prior to the placement of the
crown

Guelmann et al reported that Dura Crown, Kinder Krown, and
NuSmile crowns were significantly more retentive when
crimping and cement were combined than non veneered crowns.
• Guelmann M, Gehring DF, Turner C. Retention of veneered stainless steel
crowns on replicate typodont primary incisors: an in vitro study. Pediatr Dent
2003;25:275-8.

7. New Millennium Crown:
• They were introduced in market by the
Success Essentials, Space Maintain
Laboratory.
• These crowns are made up of composite
resin material that is laboratory enhanced.
Advantage:
• they can be finished and reshaped with a
high-speed finishing bur.

Disadvantages:
• They are very brittle
• More expensive than other crown forms
• Cannot be crimped.

8. Nu Smile crowns
• NuSmile crowns have the most natural looking veneer
facing
• Available in 2 sizes i.e regular and large for centrals,
laterals and canines.
• They have facing only on the labial side, allowing
crimping possible only on the lingual side.
• Waggoner WF. Restoring primary anterior teeth: Review. Pediatr Dent
2002;24:511- 6.

Advantages :
• Natural looking crowns
• Autoclavable
• Good esthetics
• Increased longevity
• Patient- parent’s satisfaction
• Less chairside time
• Will not discolor

Disadvantages :
• Poor gingival health
• Costly
• Bulky
• Crimping may lead to fracture

• MacLean et al concluded that Nu Smile crowns are the most
clinically successful full coverage restorations for the anterior
primary teeth with severe decay.
• MacLean JK, Champagne CE, Waggoner WF, Ditmyer MM, Casamassimo P.
Clinical outcomes for primary anterior teeth treated with prevennered stainless
steel crowns. Pediatr Dent.2007;29(5):377-81

9. Whiter Biter crowns:
• Whiter Biter crowns are preveneered stainless steel crowns
which have a polymeric coating with a polyester/epoxy hybrid
composition.
• coating is very thin but it does not peel or chip under normal
use and mastication.
• Roberts et al found that 32% of the crowns lose some of the
esthetic white facing.
• Roberts C, Lee JY, Wright JT. Clinical evaluation of and parental satisfaction
with resin-faced stainless steel crowns. Pediatr Dent. 2001;23(1):28-31.

10. Cerec crowns – All ceramic crowns
• Cerec crowns use CAD/CAM technology for
the fabrication of the crowns.
• The whole procedure can be completed in a
single visit.
• A digital image of the prepared tooth is taken
and then converted into 3D computerized
model of tooth,
• Model is used as a model for fabrication of the
crown.
• The ceramic blocks come in a wide variety of
shades and colors

Advantages
• Single visit
• Time saving
• No temporization required
• Improved esthetics
• Very durable

Disadvantages
• Very expensive
• Requires extra training on dentist’s part to know the
technology

11.Biologic crowns:
• This procedure was published as a case report
first in 1964 by Chosak and Eildeman.
• It is a technique in which fragment reattachment
using natural teeth is done and it is known as
biologic restorations.
• It meets the esthetic as well as standards of
natural teeth.
• They can be made from fragments selected from
natural extracted teeth or from a bank of tooth
tissues and can be bonded to the tooth with dual
cure composite.

Advantages
• Natural esthetics
• Superficial smoothness and cervical adaptation compatible to
surrounding teeth
• Avoids long clinical appointments
• Avoids laborious techniques
• Inexpensive

Disadvantages
• Lack of patient acceptance
• Lack of availability of teeth with similar structure, texture and
color
• Longevity is poor
• Need of tooth bank

• Sanches et al evaluated the biological restorations as a
treatment option for primary molars and found that it provided
a good alternative to other esthetic restorative options.
• Sanches K, de Carvalho FK, Nelson-Filho P, Assed S, Silva FW, de Queiroz AM.
Biological restorations as a treatment option for primary molars with extensive
coronal destruction-- report of two cases. Braz Dent J. 2007;18(3):248-52.

Restoration
And Placement
Area
Esthetics Durability Time For
Placement
Selection
Criteria
Stainless steel crowns
(posterior teeth)
poor • Very good
• Very retentive
Fast • Esthetics not
involved
• Severely decayed
teeth
• Use when unable to
control gingival
hemorrhage or
moisture
• Less than ideal
patient cooperation
Open faced stainless steel
crowns ( posterior and
anterior teeth)
• Fair
• Metal shows
through facing
• Good
• Crown retentive but
facing may dislodge
• Long
• 2 step process:
- crown cementation
- composite placement
teeth
• Good durability
• Retention needed (
bruxism, trauma prone
child)
• Parent concerned
about esthetics)
Resin (composite) strip
crowns. (anterior teeth)
• Very good • Requires adequate
tooth structure for
retention
• Easily fractured with
trauma or traumatic
occlusion
• Will vary with ability
to isolate teeth and
control moisture
• Most technique
sensitive
• Esthetics are of great
concern
• Adequate tooth
structure
• Patient not prone to
trauma
• Patient cooperative

Pre-vennered
stainless steel
crowns
(posterior and
anterior teeth)
• Good
• Limited
shades
• Good
• Crown
retentive but
facings may
break
• Moderate
• Longer than
SSC due to
more tooth
reduction and
adaption
teeth.
• Good durability
and retention
needed.
• Child is trauma
prone or bruxes.
• Parent concerned
about esthetics.
• More expensive
than other
restorations.
Zirconia crowns.
(Posterior and
anterior teeth)
• Very
good
• Requires
adequate tooth
structure for
retention.
• Less prone to
fracture than
composite strip
crowns
Not as technique
sensitive as
composite strip
crowns.
• Adequate tooth
structure.
• Patient
cooperative.

DISINFECTION OF CROWN
• Autoclave sterilization is not recommended for
PVSSCs as their lies the risk of discoloration of facing
material.
• Therefore chemical sterilization(glutaraldehyde) is
recommended for these crowns.
• Zirconium crowns are autoclavable.
• Also chemical disinfectants from various brands are
available in market.
Attari N, Robert JF. Restoration of primary teeth with crowns-a systemic
review of the literature.Eur Arch Pediatr Dent. 2006 Jan;7(2):58-62.
NuSmile Pediatric Crowns. Clinician‟s #1 choice for esthetic crowns.
Available at: “http://www.webcitation.org/query?
url=http%3A%2F%2Fwww. nusmilecrowns.com%2F&date=2014-05-05”.
Accessed November 12, 2014.

PREPARATION FOR CEMENTATION
• Rinse preparation and removal all blood and residue from
tooth.
• If bleeding continues, squeeze the preparation with a moist
2*2 guaze or carefully apply Superoxol to the tissue using a
micro brush.

CEMENTATION
• Cementation is most important step to creating a beautiful
smile.
• Centrals should always be cemented together first and then
the laterals.
• Consistent, firm finger pressure should be applied during
cementation using glass ionomer cement.
• The crown should remain undisturbed until the cement has
completely hardened.

• Wiping excess cement from the facial embrasure will allow a
clearer facial view and insure a better final alignment,
dramatically improving the final esthetic result.
• Tooth labelling can be scratched off with a spoon or polished
off with coarse prophy paste.

CONCLUSION
• Esthetics has become a respectable concept in dentistry today.
approach of pediatric esthetic in dentistry must not be just achieving
a beautiful smile and rather it must be achieving a healthy beautiful
smile.
• Dentists who care for children and adolescents have wonderful task
and ability to create beautiful smile for these young patients.
Advent of different techniques, devices, and materials help in
creating beautiful restorations which help children and adolescents
improve their self- image.
• As we know that the child’s esthetics is the guide to the adult
esthetics.

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