Stainless Steel Crown

The following instruments are needed

Materials needed:

Rubber Dam set-up

Burs: Tapered diamond burs; round carbide burs; #245 bur

1. Local anesthesia is administered. (This is necessary for gingival anesthesia even if tooth has had a pulpotomy or pulpectomy).

2. A rubber dam should be used. Wooden wedges are placed interproximally.

3. Measure the mesial-distal width of the tooth with a Boley gauge or a perio probe. An appropriate crown is selected.

4. The excavation of caries is done or appropriate pulp therapy has been completed prior to the crown preparation. Vitrebond (glass ionomer) is placed in deep excavations.

If a non-pre-contoured crown (Unitek) is used:

5. First the occlusal reduction is completed with a #245 carbide bur. The total reduction should be 1mm. The reduction follows the occlusal anatomy and should begin with guide cuts 1mm deep on the marginal ridges, buccal, and lingual occlusal grooves. These guide cuts are then connected to complete the occlusal reduction.

6. The proximal reductions are begun by creating a guide cut on the buccal surface. The reduction is continued using a fine tapered diamond from buccal to gingival until contact is completely broken. Any ledge should be removed.

7. After the occlusal and proximal reductions are completed, line angles are rounded.

8. The selected crown is placed on the tooth. The crown should go to place with moderate finger pressure. It should not rotate on the tooth. It should recreate the mesial-distal and buccal-lingual dimensions of the tooth.

9. After an appropriate crown is selected and seated, it is scored at the margin of the gingiva with a sharp spoon excavator.

10. Remove the crown with a large spoon excavator from the stainless steel crown kit. Place gauze on the lingual of the tooth to prevent the patient from swallowing the crown. Shorten, using crown shears or a heatless stone, leaving it 1mm longer than the scored line. Remove any roughness from the margins.

11. The crown is then reseated and checked to make sure that the marginal ridges are at the appropriate height (same height as adjacent teeth) and the cervical margin is about 1mm subgingival. Check with an explorer to determine open margins.

12. The #114 contouring pliers are used to create the cervical bulge. Crimping pliers are used to adapt the margin of the crown.

13. The crown is then placed back on the tooth having the patient occlude. The margins are checked. A well-fit crown cannot be removed with an explorer.

14. The crown is removed with a large spoon excavator. Repeat steps 10-13 if additional adjustments are necessary.

15. The margins are then thinned with a green stone and polished with Burlew wheels.

If a pre-crimped and pre-contoured crown (Ion or 3M) is used:

1. Follow steps 5 - 8.

2. The crown is then checked to make sure that the marginal ridges are at the appropriate height (same height as adjacent teeth) and the cervical margin is about 1mm subgingival. Check with an explorer to determine open margins.

3. Remove the crown with a large spoon excavator from the stainless steel crown kit. If necessary, crimping pliers are used to adapt the margin of the crown.

For both types of crowns:

19. The crown is cemented using Ketac Cem mixed to a luting consistency. The crown is filled with the cement. It is then seated on the tooth (which has been dried and isolated). Immediately remove gross excess with moistened 2x2 gauze. The occlusion is checked and the patient is asked to bite gently on a cotton roll until the cement is set.

17. The excess cement is removed from around the tooth. Dental floss is passed through the contacts to remove excess interproximal cement.

18. Home care instructions are given to the patient and parent. The parent is advised of possible gingival irritation. The patient is asked to avoid chewing gum and sticky foods.