DEPARTMENT OF PEDODONTICS

ANTERIOR CROWNS IN PEDIATRIC DENTISTRY PRESENTED BY: PAYAL BHOIR

CONTENTSIntroductionANTERIOR STAINLESS STEEL CROWNSPREVENEERED STAINLESS STEEL CROWNSBONDED CROWNSSTRIP CROWNSSHELL CROWNSRECENT DEVE LOPEMENT FOR ANTERIOR CROWNS IN PEDIATRIC DENTISTRY

INTRODUCTION

The healthy oral cavity is primary requisite for beautiful looks. As dental caries is most chronic disease of childhood clinical examination of ECC discloses a distinctive pattern of teeth involvement i.e maxillary central insicors,lateral incisors, maxillary and mandibular 1st primary molars

Stainless Steel Crowns/Open Faced Stainless Steel Crowns

Stainless steel crowns were introduced to pediatric dentistry by the Rocky mountain company in 1947 and made popular by W.P.Humphrey in 1950,which proved to be boon to clinical pediatric dental practice.

Originally it was intended for restoration of posterior primary and young permanent teeth, its use was expanded to badly decayed anterior teeth.

Although more durable and retentive than amalgam or composite they are unaesthetic, especially on anterior teeth.Open faced stainless steel crowns combine strength, durability, and improved aesthetics, however they are time consuming to place as the composite facing cannot be placed until the stainless steel crown cement sets.

The advent of composite bonding, allowed for a composite facing to be placed on facial surface of tooth, thus improving aestheticsBleeding of the color of the metal margins surrounding the composite adds a grayish tinge to the tooth that is accentuated next to white enamel

The advantage and disadvantages of stainless steel crowns and open faced stainless steel crowns are summarized below:-Stainless steel crownsAdvantagesDurability, wear well and retentive.The time for placement is fast.They may be used when gingival hemorrhage or moisture is present or when the patient exhibits less than ideal cooperation.They are inexpensive.

Disadvantages Aesthetics are extremely poor. Some parents may opt for extractions rather than restoration of the teeth.

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Pre-veneered Stainless Steel Crowns

Pre-veneered stainless steel crowns were introduced in the mid 1990s.They are aesthetic, placement and cementation are not significant affected by hemorrhage and saliva and can be placed in a single appointmentThe Stainless steel crown is covered on its buccal or facial surface with a tooth colored coating of polyester/epoxy hybrid composition.A clinical disadvantage is they are relatively inflexible as the resin facing is brittle and tends to fracture when subjected to heavy forces or crimping.

Pre veneered crowns stainless steel crowns are available which are

1 Cheng crowns These are stainless steel pediatric crowns faced with a high quality composite, mesh;based with a light cured composite It presents a unique solution for natural looking stain resistant teeth It is available in short and regular lenghts and sizes suitable for central, lateral and cuspids

Disadvantage ExpensiveFracture of veneers' during crimping Advantages

Procedure is completed in one visit with minimal patient discomfort They can undergo heat sterilization without significant effect on bond strength and colour

Dura Crowns Crowns can be crimped labially and lingually, can be easily trimmed with crown scissor, easily festooned and has got full knife-edgeThese crowns with veener facings were more retentive than the nonveenered ones when cement and crimping were combined

Kinder Crowns

Kinder crowns are most often natural shade and contour available for pediatric patients Greater depth and vitality of composite reveal a natural smile without bulky chiclet look of other restoration.They come in two shades Pedo 1- bleached white shade Pedo 2 natural shade

Kinder crowns are designed with Incisal lockBy addind more composite they become strong without sacrificing form and function

PEDO PEARLSThese are heavy gauge aluminium crowns coated with US Food and Drug Administration food grade powder coating and epoxy resinThey have universal anatomy and can be used on either side easy to cut crimp without chipping and peelingDisadvantage - less durabiliy

Pedo pearls

BONDED CROWNSPolycarbonate crowns Polycarbonates are polyesters of carbonic acid They exibit high impact strength and rigidity and are termed thermoplastic since they are moulded as solids by heat and pressure into desired .It is esthetic than SSC, easy to trim and can be adjusted with pliersDisadvantage do not resist abrasive forces hence contraindicated in bruxism and deep bite

IndicationsFull coverage restoration of maxillary anterior teeth with extensive cariesEarly childhood cariesDeformities in tooth structure

ContrindicaionDeep bite BruxismHigh funtionality teeth

Placement of carbonate crowns

MODIFIED POLYCARBONATE CROWNSThe crowns are made of polycarbonate resin incorporating microglass fibers which not only permit crown adjustment with pliers but gives good durability and strengthThey are time saving , easy to trim and can be adjusted with pliersProvides good durability and strenghtSmooth surface finish for patiend comfort n prevents plaque accumulation

STRIP CROWNSThese are celluloid crowns that are most effective for extensive carious teethThese are commonly used crown forms filled with composite and bonded on to tooth

AdvantagesEasy to place and remove Less time consumingParent/ patient pleasingIdeal for ankylosed teeth

Simple to fit and trimRemoval is as fast and easyEasily matches natural dentitionEasy shade control with compositeSuperior esthetic qualityLarge selection of sixeEasy to repair

Strip crown placement

SHELL CROWNS

A noval technique for esthetic rehabilitation of maxillary anteriors with custom made composite shell crowns with an indirect approacgPerfectioner of restoration using silicone positionerIndierct approach so most of the work is done on casts thereby the chair side time is reduced

Placement of shell crowns

RECENT DEVELOPMENTS FOR ANTERIOR CROWNS PEDO JACKET It is tooth coloured copolyester material which is filled with resin and left on tooth after polymerization instead of bieng removedIt does not split , stain or crackCrowns can be easily trimmedDisadvantage only one size is available

Pedo jacket

NEW MILLENIUM

These crowns are made up of lab enhanced composite material or zirconia

ART GLASS CROWNSThese are only patented preformed crowns for pediatric usageArtglass contain multifunctional methylmethacrylate which has the ability to form three dimensional network with a highly crosslinked structure When the matrix is cured highly crosslinked organic glass forms one of the toughest material available in dentistry

Shade selection is simplified by matching to vita shade systemHigh organic filler makes it more colour stable and plaque resistantFlexural strenght is 60% higher than porcelain, less chances of fractureEasily adjusted or repaired intraorallyProvides esthetic and lastiong qualitiesOffers ease and bondability of composite

Art glass crowns

REFERENCESNIKLHIL MARWAH; TEXTBOOK OF PEDIATRIC DENTISTRY 3RD EDITION

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