The Use of Stainless Steel Crowns

Resident: Swan

Article Title: The Use of Stainless Steel Crowns

Author: N. Sue Seale

Journal: Pediatric Dentistry

Volume (Number): 24:5 2002

Major Topic: A discussion of the indications for and efficacy of stainless steel crowns for primary molars

Main Purpose: Discuss both clear-cut and not so clear-cut instances where an SSC would be a good treatment option

Type of Article: Position Paper

Main Points of Discussion:

--Advantages of Stainless steel Crowns: Extremely durable, relatively inexpensive, minimal technique sensitivity, offers full coronal coverage.

--Main Disadvantage: Esthetics

--Clear cut applications: following pulpectomy/pulpotomy, and in teeth with developmental defects, large multisurface carious lesions, or fractures.

--Where it becomes more difficult: In treating lesions small enough to allow other restorative options. We need to consider caries risk, restoration longevity, and cost effectiveness

Caries Risk: Study cited that reported 8X increase in buccal/lingual/approximal caries over a two year period in 3 year olds with decay on the maxillary anterior teeth. Another study reported that 57% of children with proximal molar carious lesions in the primary dentition developed additional interproximal primary molar lesions in the mixed dentition. Conclusion: kids develop predictable caries patterns over time.

“High Risk” Indicators: dmfs greater than child’s age, 2 or more new carious lesions in 1 year, numerous white spot lesions, high S. Mutans counts, low socioeconomic status, relatives with high caries rates, appliances in mouth, and history of sugary diet. Also consider ability to recall child on a regular basis.

**With high risk patients, more aggressive treatment with SSCs is better over time

Restoration Longevity: Studies have documented the superior durability and life span of SSCs over class II amalgams. Study by Randall: In 5 published sets of data with average follow up time of 5 years, amalgam failures rate was 2 to 7 times more than that of SSCs.

-Studies show amalgam life expectancy to be approx. 2 years. When restoration needs to last more than 2 years, according to this author, best practice would be to chose an SSC in multisurface restorations of molars. Also, SSCs can be placed with little compromise in a difficult child, where moisture control is unrealistic.

Cost Effectiveness: Randall found 3 studies that examined the cost effectiveness of SSCs vs. amalgams. Two reported the SSC was more cost effective, one reported SSC to be more expensive over time (last study included both Cl I and Cl II amalgams). In studies, most common failure for SSCs is when crown falls off (can often re-cement same crown,= less cost, whereas replacement for a failed amalgam is often an SSC,=more cost). SSCs are recommended for children who require tx under GA=more cost effective, likely we’ll see them in the OR less often.

Summary and Assessment: SSCs are durable, long-lasting restorations that outperform Cl. II amalgams across the board. While there are several clear cut situations that call for their use, oftentimes we need to judge for ourselves. When making tx decisions and discussing with parents, we should consider caries risk, restoration longevity, and cost effectiveness. I liked this article because it succinctly summarized what should be going on in our minds when we are making these types of treatment decisions.