A Simplified Isolation Technique for Preparation and Placement of Resin Composite Strip Crowns

Resident: Roberts

Date: 10/3/10

Article title: A Simplified Isolation Technique for Preparation and Placement of Resin Composite Strip Crowns

Authors: Psaltis, Gregory

Journal: Pediatric Dentistry

Volume: 30:5

Year: 2008

Discussion:

Resin composite strip crowns have been utilized for over 2 decades to restore carious primary teeth. They are the most esthetic looking anterior restoration, they are also the most technique sensitive. Restoration of a severely decayed primary tooth with a strip crown is often complicated by hemorrhage in the operative site. Inflamed, bleeding gingiva may interfere with proper curing of the restorations, resulting in discolored crowns due to excessive bleeding during the curing process. Proper isolation and hemostasis is crucial for getting ideal results. Traditionally, the routine use of ligature ties to deflect the gingival tissue and retain the rubber dam in place has been recommended to address this problem. The purpose of this report was to describe a simple, relatively inexpensive alternative technique for placing strip crowns by utilizing orthodontic elastomers

Ligature ties often cause bleeding and discomfort for the patient. Their use may inhibit rapid removal of the rubber dam during treatment. The removal of the ligatures which are situated under the cured restoration can also be difficult to removed once the composite restoration has cured.

The use of orthodontic elastomeric ligatures, a.k.a. Alastiks can be a simple method used to replace the ligature ties. This techniques success depends on 3 key steps

1. Use a rubber dam with 4 holes of the smallest size possible. The holes are to punched directly around each maxillary incisor being careful not to place the holes to closely together. This allows the tightest fit and eliminates leakage.
2. Place orthodontic elastomers over each incisor after placement of the rubber dam. This is accomplished by threading 2 strands of floss through each elastomer and then stretching it over the tooth. When placed correctly the will retract the dam and gingival tissues. Once in place remove the lingual piece of floss but leave the labial one in place.
3. Remove the elastomers with the labial floss after completion of the crown. If left in place they can asymptomatically crawl up the conically shaped roots and cause an atraumatic and asymptomatic extraction. The labial floss will help to serve as a reminder and assist in the elastomers removal.