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Pediatric Restorative Dentistry Full Coverage Restorations
Brian Talley, DMD
Halley White Pediatric Dentistry, P.A. Wilmington, NC
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Basic Restorative Tenets for Primary Teeth
Restorations in younger patients have shorter life spans
At all ages, 1st restoration in a tooth lasts longer than 2nd
All restorations in 1st primary molars have shorter survival than in 2nd primary molars
Longevity of Cl. II < Cl. I in primary molars
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Indications for Anterior Crowns
Multiple decayed surfaces
Extensive decalcifications
Incisal edge involvement
Hypoplasia
In cases of poor moisture &/or hemorrhage control
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Contraindications
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Full Coverage Restorations for Primary Front Teeth
Stainless steel crown with resin window (open-faced)
Resin-veneered crowns
Strip crowns
Stainless steel crowns
Polycarboxylate crowns
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Comparison: Primary Incisor Crowns
Time
required
Technical
difficulty
Longevity
durability Esthetics
SSC ** ** ***** *
Open-
faced SSC *** *** **** **
Veneered *** ** *** ***
Strip
crown ***** ***** *** *****
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Open-face(d) SSC
Cement SSC
Cut out window
Fill with resin-based composite
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Strip Crowns
Shell is filled with resin-based composite and slipped over prepared tooth
Require sufficient tooth structure
Technique sensitive
Underutilized
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Strip Crown Technique
1. Prep tooth
2. Prepare shell
3. Etch & bond
4. Fill and fit shell
5. Cure
6. Remove shell
7. Adapt margins
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Case: Strip Crowns
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Pre-veneered SSC Inflexible, brittle resin veneer
No crimping of lingual surface or forcing crowns on tooth
Significant removal of tooth structure to allow passive fit
Bulky size
Expensive ($18/crown)
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Clinical Outcomes for Primary Anterior Teeth Treated with Preveneered SSCs
Evaluation of 226 crowns in 46 patients
Mean age 4y 2m
Mean observation time 12.9 months
91% placed under general anesthesia
MacLean JK et al. Pediatr Dent 2007; 29:377-81
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Clinical Outcomes for Primary Anterior Teeth Treated with Pre-veneered SSCs
Results
Shade: 4% matching - 95% were lighter than natural teeth
Size: 86% natural - 14% bulky
Fracture resistance: 88% resisted fracture for < 6months
Wear resistance: 71% resisted wear for < 6 months; more attrition with increased time and bulky crowns
Appearance: 37% excellent - 50% good - 9% poor
MacLean JK et al. Pediatr Dent 2007; 29:377-81
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Case: Veneered Crowns
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Case: Polycarboxylate Crowns
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Wear and Tear
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Stainless Steel Crown
Introduced to pediatric dentistry in 1950 by Humphrey
Parallel walls
Pre-trimmed and pre-contoured
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Indications
Restoration of primary & permanent teeth Extensive caries, large, or multiple surface lesions
Cervical decalcification
Developmental defects
When other materials would fail or failed
Following pulpotomy/pulpectomy
In patients who require treatment under general anesthesia
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Properties
Extremely durable, relatively inexpensive
Minimal technique sensitivity during placement
Superior to amalgam in high-caries risk patients with decreased ability to cooperate (longevity, cost, patient convenience)
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SSC Preparation Technique
Wrong!
Too much taper Ledge
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Preparation Technique ctd.
Wrong
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Clinical Examples
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Case Study
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Questions?