Overview of Stainless Steel Crowns in Primary Dentition
Dental cavities (also known as caries) are very common, especially in young children. It’s essential to take care of baby teeth that have decay because they play an important role in essential parts of life like eating, speaking, and keeping the correct amount of space in the mouth for the adult teeth that come later. The treatment of cavities in children has been an ongoing problem due to several reasons, such as a child’s fear or discomfort, and the need for treatments that can last until the baby tooth naturally falls out.
Stainless steel crowns are often used to fix and save the rest of a badly damaged or decayed tooth. Stainless steel crowns were first brought into children’s dentistry in 1947. They have been proven to be better than other materials like amalgam and composite, in terms of how long they last for over fifty years. Plus, they are cost-effective, reliable, and durable when you need full coverage for a tooth.
Research supports using stainless steel crowns in young children at high risk for cavities. Despite their many benefits, some professionals don’t prefer to use stainless steel crowns because they think they are hard to apply. However, they’re actually easier to put on than filling a cavity inside a tooth, and they provide much better results in the long run.
Why do People Need Stainless Steel Crowns in Primary Dentition
If you’ve had a dental procedure on the pulp of your tooth (the central part that has nerves and blood vessels), it’s sometimes necessary to follow this up with a special dental treatment.
This is also true if you have several cavities in your teeth that need treatment or if you’re at a high risk of developing cavities. Some people are more prone to cavities due to factors like diet, oral hygiene habits, or even genetics.
Frequently, milk teeth (or deciduous teeth) that have certain developmental conditions also require this special treatment. Conditions such as amelogenesis imperfecta (a condition affecting the formation of enamel), dentinogenesis imperfecta (a condition affecting dentin formation), and enamel hypoplasia (underdeveloped enamel) are some examples of this.
In case of teeth eroding extensively due to aging, grinding, or certain medical conditions, this treatment is helpful. Also, if your tooth is refilled in such a way that the filling is likely to fail – for instance, if the filling goes beyond the natural contours of your tooth – this treatment might be employed.
A tooth that has been fractured or broken and a tooth being used to support a space maintainer (a device helping preserve space for a permanent tooth to grow in) could also need this type of dental treatment.
Lastly, if you find it hard to attend regular follow-up appointments, this treatment can provide a long-term solution to ensure that your oral health doesn’t worsen due to lack of regular check-ups.
When a Person Should Avoid Stainless Steel Crowns in Primary Dentition
There are certain cases where a dental procedure might not be possible:
1. If baby teeth (primary teeth) have lost more than half of their roots, the procedure might not be possible. This can be due to a condition called root resorption, where the body mistakenly breaks down and absorbs the material of the tooth root.
2. If a baby tooth is about to fall out on its own in the near future (6 to 12 months), then a dental procedure might not be necessary or beneficial.
3. If a tooth is very wobbly (has excessive mobility), it might be too risky or ineffective to carry out a dental procedure.
4. Some dental procedures use nickel in the materials. So, if a patient is allergic or sensitive to nickel, then those procedures wouldn’t be safe for them.
5. Sometimes, the successful dental procedure needs a patient to cooperate so that a crown (a cap that covers a tooth) can be properly fitted. If a patient is not able to cooperate enough for this, then a procedure might not be possible.
Equipment used for Stainless Steel Crowns in Primary Dentition
There are several tools and materials that are necessary when performing dental procedures. Here’s a simplified list explaining just what each tool is and why it’s used:
Burs and Stones:
1. No. 169L or No. 69L F.G: These are special types of dental burs (drill bits) used for shaping and removing parts of a tooth. [10]
2. Round bur: Another type of dental bur used specifically for removing tooth decay (the areas of your tooth damaged by cavities).
3. Flame shaped diamond bur or round end tapered bur: These are particular shapes of burs to get a precise shaping of the tooth.
4. Long thin tapered bur: An elongated bur that’s used for precision and control during the dental procedure.
Other materials:
1. Rough or whitening polish wheels: Tools used for polishing and enhancing the appearance of your teeth.
2. Greenstone or heatless stone/rubber wheel stone: These are used for the final touches, making your teeth smooth after the procedure. [11]
3. Wire wheel: A tool used for finishing the surface of a dental crown (a type of dental restoration).
4. Cement medium – glass slab/cement mixing pad, spatula, cement: These are materials required to prepare dental cement, which is used to secure certain types of dental restorations, such as crowns.
5. Rubber dam armamentarium: Dental dams are sheets of rubber placed in the mouth during dental procedures to isolate the area being treated.
6. Local anesthesia: This is a medication that numbs a specific area of your mouth so you won’t feel pain during the procedure.
7. Dental floss: A cord of thin filaments used to remove food and dental plaque from between teeth in areas a toothbrush is unable to reach.
8. Pliers and instruments: These are tools used for various tasks during the dental procedure, like manipulating and positioning dental appliances.
9. Sharp explorer: This is a dental tool used for examining your teeth. It’s especially useful for marking the boundaries of a dental crown.
Preparing for Stainless Steel Crowns in Primary Dentition
Before the dentist begins fixing a tooth with a crown, they need to follow a number of steps.
Choosing the Right Crown
The dentist finds the right crown using a few different methods. One is by measuring the size of the tooth before starting work on it. Another is by using the trial fitting method. The third option is choosing the crown after preparing the tooth.
If there’s some space loss behind the lower, front tooth, this can make the choice of crown more complicated. In this case, the dentist will take measurements of the opposite tooth in your mouth. The crown should lock into place easily when the dentist tests it. They also look at the chewing surface of your tooth, the gaps between your teeth, and if the crown feels the right height.
Checking the Bite
Before placing a protective barrier called a rubber dam and starting work on your tooth, the dentist will check:
1. If the tooth opposite the one being worked on has moved out of place due to tooth decay
2. If there’s drift towards the front of your mouth because tooth decay has caused space loss between the teeth
3. If there are gaps or crowded teeth
4. The relationship of your front and back teeth on both sides, either directly in your mouth or with dental casts
5. The central line of your teeth and the relationship between the peak of your teeth and the low points
Local Anesthesia
The dentist will numb the tooth and nearby soft tissues to avoid any pain or discomfort from the work and fitting of the crown. Some patients may need the roof of their mouth numbed as well, in which case a local anesthetic injection is generally better than a topical numbing cream.
When the dentist is preparing a tooth that’s had root treatment, reducing the contact points at the front and back may cause discomfort to the gums. In this case, applying topical anesthesia may be enough.
Rubber Dam Isolation
The dentist will usually put a rubber dam in place. This helps protect the tissues around the tooth, makes the area clearer to see, helps manage the patient’s comfort or anxiety, and stops any chance of you swallowing the crown.
Wedge Placement
Often, dentists will use wooden wedges before removing the tooth’s decay and shaping it for a crown. These help keep the teeth on either side separate and avoid any accidental damage to the enamel, the hard, protective surface of the tooth.
Removing Tooth Decay
Cavity removal and any necessary root treatments can be done before or after shaping the tooth for the crown. But, most of the time, the dentist can prepare the tooth for the crown while they’re removing cavities.
How is Stainless Steel Crowns in Primary Dentition performed
Dentists have different techniques for preparing a tooth for a crown. Some believe it is better to start with the top (occlusal) surface because it gives better access to the sides (proximal areas) of the tooth. Others think it’s best to work on the proximal areas before the occlusal surface. Both strategies aim to carefully eliminate decay and prepare the tooth’s surface. It’s crucial to take your time when dealing with the proximal areas because this can affect the diagnosis of potential pulp (the tissue inside the tooth) exposure caused by gum bleeding.
To prepare the occlusal surface, dentists use a special tool called a bur to reduce 1.5 to 2.0 mm of the surface. It’s important to maintain the original shape of the tooth’s cusps (pointy parts) as much as possible. If a lot of the occlusal surface has been lost due to decay, the dentist uses the edges of neighbouring teeth as a reference.
The proximal surfaces are also reduced using a high-speed bur to make room for the crown and create a smooth, gentle finish towards the gum. The goal is to clear the contact points between the teeth so that a probe could pass through them.
Dentists also work on the outer (buccal) and inner (lingual) surfaces of the tooth, though this step is optional. Some suggest preparing these areas to make the process of placing the crown easier, while others believe minimal preparation is necessary. This step depends on the shape of the tooth and the need to accommodate the crown. The dentist usually tries on the selected crown before moving on to the buccal and lingual reduction.
Finally, the dentist rounds all the sharp edges and blends the surfaces together by holding the bur parallel to the tooth’s long axis. Any remaining decay is removed at this point and if there’s pulp involvement, the dentist may need to perform a pulp therapy. It’s important to keep the area covered with a rubber dam to maintain cleanliness.
Adapting the crown so it fits perfectly is crucial to ensure it stays in place and protects your gums. An ill-fitted crown could lead to plaque and bacteria build-up, which results in gum disease and tooth decay.
The dentist will put the crown on the tooth, making sure it fits well and follows the natural contours of your gums. The crown is then adapted and shaped to fit the tooth perfectly. After several adjustments, the tooth and crown are X-rayed to ensure complete coverage.
The finishing step involves using a stone tool to make a smooth finish at the bottom edge of the crown. This is then polished to make it smooth and shiny.
The crown is then cemented onto the prepared tooth. It’s secured tightly with special cement and kept under pressure while it hardens. Removing any extra cement is an essential part of the process.
When more than one crown is required on the same side, both teeth are prepared together. The dentist may need to reduce slightly more of the tooth to make it easier to place multiple crowns. While working with more than one tooth, it’s important to complete the reduction of one tooth before working on another to prevent improper reduction.
Possible Complications of Stainless Steel Crowns in Primary Dentition
If the dentist does not use the drill correctly during your tooth treatment, it can cause an unwanted overhang, also known as an interproximal ledge. If this ledge is not removed, it can disrupt the placement of the crown, which is the cap that covers your damaged tooth.
Research has shown a connection between gum disease, or gingivitis, and issues with the edges of the crown, such as the crown not fitting the tooth properly or leftover dental cement. To avoid these problems, the dentist must make sure the crown fits perfectly. After putting the crown in place, they will carefully smooth the edges. They should also talk to you about how to keep your mouth clean to prevent gum disease.
One risk during the dental procedure is that you might accidentally swallow or inhale the crown. To avoid this, the dentist will place a protective sheet called a rubber dam over your mouth until the cement is placed. Accidents can happen, even with all these precautions. If this happens, it’s important for the dentist and their staff to stay calm and act quickly to keep you safe. If you accidentally swallow or inhale the crown, the dentist might use strong suction, pat you on the back or use a technique called the Heimlich maneuver to try to remove the crown. If these attempts are not successful, they will refer you for a chest x-ray. If the crown is in your lung or windpipe, a procedure called a bronchoscopy can be used to take it out. In some cases, you may need immediate medical or surgical treatment.
What Else Should I Know About Stainless Steel Crowns in Primary Dentition?
Primary teeth, also known as baby teeth, are more likely to get cavities than adult teeth. This is because they have a larger central part, known as pulp, which demands a special design for fillings. That’s why these teeth often need a filling that covers the whole tooth.
There are different materials used for fillings, but stainless steel crowns are most commonly used, even though they may not look as good as some other options. This is because they have a few key advantages:
- Durability: They last a long time.
- Efficiency: They work very well.
- Longevity: They don’t need to be replaced often.
- Cost-Effectiveness: They are a good option if you are on a budget.
- Reliability: They are known to be a safe and predictable option.
While there are other options for fillings that look more like a tooth, they are either more expensive or they require removing more of the tooth, which can increase the chances of exposing the tooth’s pulp.