Marginal Adaptation of Stainless Steel Crowns

Meghan Sullivan Walsh November 28, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Marginal Adaptation of Stainless Steel Crowns

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Marginal Adaptation of Stainless Steel Crowns

Authors: Theodore P. Croll, DDS; David W. Epstein, DDS, MSD; Cosmo R. Castaldo, DDS, MSD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 25:3, 2003, pages 249-252

Major Topic: The procedure of adapting, finishing, and polishing crown margins.

Overview of Method of Research: Report gives details of methods used to adapt SSC margins as precisely as possible to prepared teeth.

Findings:

Technique for SSC procedure:

Tooth preparation for the SSC Includes debridement of carious tooth structure and placement of liner on dentin as indicated. Tooth preparation is designed such that the form of the tooth can be replicated by that of the SSC. After proper size crown form is selected, marginal adaptation of the crown is as follows:

1)Using a abrasive wheel, crown length is custom cut. The abrasive wheel is recommended by the authors rather than scissors for a more precise reduction. The wheel is used to recreate marginal ridge height in relationship to the adjacent teeth and have sufficient extension to overlap the cervical bulge. On primary teeth the margins can be at or slightly above the CEJ. In an adult molar the crown margin of a SSC should be coronal to the CEJ so as not to compromise the fit of a precision cast crown. During crown size selection, if the selected crown does not fit the prepared tooth, either the tooth is insufficiently prepared, the crown is too small or both.

2) Using a crimping plier the edge of the crown form is bent slightly inward around the crown periphery.

3) The abrasive wheel is used along the edges toward the margins from the occlusal direction (counterclockwise.) This will both thin the margins and curve it slightly towards the axial walls of the tooth.

4)The surfaces of the crown are then smoothed and polished with a rubber wheel in the same direction.

5) A polishing cloth or chamois wheel using Tripoli polishing agent and rouge can then be used for final finishing.

Key Points: Summary: The authors state that the methods described are used for both primary and permanent molar SSC forms and are expected to remain in place for 5-15 years. The clinician should strive to replicate the natural state when repairing a tooth. The goal is to restore it’s form, function and purpose in a biologically acceptable manner.

Assessment of the Article: While I understand the value of preparing an SSC in the manner with which is described above, I don’t think it has many practical uses in a pediatric office. The amount of time used to both trim and polish an SSC as mentioned may be difficult to obtain while placing a SSC on a wiggly 5 year old in the dental chair or in a OR setting. Pre formed SSC do have good adaptation and can serve the purpose of a 5 year restoration in a pediatric patient.