Review article Annals and Essences of Dentistry

ESTHETIC CROWNS FOR PRIMARY TEETH: A REVIEW

* Suzan Sahana, ** Aron Arun Kumar Vasa, *** Ravichandra Sekhar

* Sr. Lecturer
** Sr. Lecturer
*** Professor and Head

Department of Pedodontics & Preventive Dentistry, St. Joseph Dental College, Eluru. India

ABSTRACT:
A variety of esthetic restorative materials are available for restoring primary incisors. Each has distinct
advantages and disadvantages and the clinical conditions of placement may be a strong determining factor so
as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of
reasons. Crowns available for restoration of primary incisors include those that are directly bonded to the tooth
which generally are made up of a resin material, and those crowns that are luted onto the tooth. This paper
reviews the published data on restorations of primary anterior teeth and various forms of full coronal restorations
for the same.

KEYWORDS: Esthetic materials, Primary anteriors, Restorations

INTRODUCTION problems, reduced masticatory efficiency and loss

3
Despite the introduction of various novel techniques of vertical dimension of occlusion. Hence it is
for restoring carious lesions in the primary incisors, important to restore crowns destroyed by caries to
still it is a challenge for the clinician to satisfy the preserve the integrity of primary dentition until its
patient effectively. It is becoming a greater concern exfoliation and eruption of permanent teeth.
as more emphasis is being placed on esthetics.
Esthetics, by definition, is the science of beauty: The purpose of this article is to review the various
that particular detail of an animate or inanimate esthetic options available for restoring the primary
1
object that makes it appealing to the eye. incisors and enhance the clinician’s ability to make
the best choice of selection for each individual
In the modern civilized cosmetically conscious situation.
world, well contoured and well aligned white teeth
set the standard for beauty. Such teeth are not only
considered attractive, but are also indicative of Full coronal restorations
nutritional health, self esteem, hygienic pride and Indications for this include:
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economic status. With the growing awareness of  Caries present on multiple surface.
the esthetic options available, there is a greater  Extensive cervical decalcification
demand for solutions to unsightly problems such as  Anteriors that have received pulp therapy
nursing bottle caries, malformed and discolored
 Anteriors that have fractured and lost most of
teeth, hypoplastic defects, tooth fractures and
the tooth structure
bruxism in children.
 Anterior teeth with multiple hypoplastic defects
or developmental disturbances
Esthetic restoration of primary anterior teeth can be
 Discolored teeth that are aesthetically
especially challenging due to the small size of the
unpleasing
teeth, close proximity of pulp to tooth surface,
 High risk patients where the oral hygiene is
relatively thin enamel and surface area for bonding,
poor but caries is minimal.
issues related to child behavior and finally cost of
2 The child’s behavior makes moisture control difficult
the treatment. Apart from a compromise in 4
in placing class III restorations
esthetics, dental destruction may also lead to
development of parafunctional habits like tongue
thrusting and speech problems, psychological

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Review article Annals and Essences of Dentistry

Restoring Primary Anterior Teeth

Intra Coronal Full Coronal

Restoration Restoration

Direct Indirec Luted Bonded

ttttttt

Stainless steel with

facing Polycarbonate
Cheng crowns Strip crowns
Kinder krowns Pedo jacket
Nu-smile New millnium
Dura-crowns Glastech
Whiter bite
Pedo pearls
Ceromo-basemetal-
childers
Crown Build up
(Restoration of Severely
Decayed Tooth)

Direct Indirec
t

1. Resin composite short post

1. Indirect composite resin
technique
crowns reinforced with a
2. Orthodontic wires shaped as
fibre glass post
Greek alphabets like alpha,
2. Biological posts &
omega, theta used as intracanal crowns
retainers

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Review article Annals and Essences of Dentistry

1. STAINLESS STEEL CROWNS It is available in upper and lower – right & left
central and lateral with 6 sizes.
Stainless steel crowns are considered to be the
most durable, economical and reliable for restoring Dura crowns
severely carious and fractured primary incisors. Crowns can be crimped labialy and lingually, can be
They are easy to place, fracture proof, wear easily trimmed with crown scissors, easily festooned
resistant and attached firmly to tooth until and has got a full-knife edge. Study has shown that
exfoliation. However there is a compromise in these crowns with veneer facings were
esthetics due to the unsightly silver metallic significantly more retentive than the nonveneered
5 7
appearance. ones when cement and crimping were combined.

MODIFICATIONS OF STAINLESS STEEL CROWNS Kinder krowns :

Kinder Krowns offer the most natural shades and
a. Facial cut out Stainless steel crowns contour available for the pediatric patient. The great
This involves placement of composite material depth and vitality from the lifelike composite reveal
in a labial fenestration of SSC. Although there is a natural smile without the bulky “Chiclet” look of
an improvement in the appearance, the other restorations. They come in 2 aesthetically
technique is time consuming and metal margins pleasing shades, Pedo 1 and Pedo 2. Pedo 2 shade
are still visible. Clinicians even face problems to is the most natural shade While Pedo 1 shade is for
control hemorrhage during application of those cases when the bleached white shade is
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composite facing. wanted.

b. Veneered Stainless steel crowns Kinder Krowns are designed with IncisaLock™ - the
Here the composite resins and thermoplastics optimal union of state-of the-art bonding procedures
are bonded to the metal. This type of and mechanical retention. By adding mechanical
preveneered crown was developed to serve as retention and more composite, Kinder Krowns are
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a convenient, durable, reliable, and esthetic strong without sacrificing form or function.
solution to the difficult challenge of restoring
TM
severely carious primary incisors. Various PEDO PEARLS
commercially available veneered SSCs include These are beautiful heavy gauge aluminum crowns
Cheng crowns, Kinder krowns, Nu-smile and coated with FDA food grade powder coating and
Whiter biter, pedo compu crowns and Dura epoxy-resin. They serve as ultimate permanent
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crowns. crown for primary teeth. Features include:
 Universal anatomy--use on either side
Cheng Crowns  Easy to cut and crimp, without chipping or
Cheng Crowns made their public debut in 1987. peeling.
These are Stainless steel pediatric anterior crowns  Composite can be added
faced with a high quality composite, mesh-based Disadvantages include less durability and the
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with a light cured composite. It presents a unique crowns are relatively soft.
solution for natural-looking Stain-resistant Crowns.
It is available for the right and left central and lateral BONDED CROWNS
as well as cuspids.
Most crown procedures can be completed in one a. Polycarbonate Crowns:
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patient visit and with less patient discomfort. These are heat molded acrylic resin used to
restore primary anterior teeth. It is esthetic
It is available in short and regular lengths and sizes than SSC, easy to trim and can be adjusted
suitable for centrals, lateral and cuspids. They can with pliers. These crowns do not resist
undergo heat sterilization without significant effect strong abrasive forces thus leading to
on their bond strength and color. Disadvantages of occasional fracture, hence it is
all preveneered crowns are fracture of veneers contraindicated in cases of Severe bruxism
6 8
during crimping and they are expensive. and deep bite.

It is a Stainless steel crown faced with high quality b. Strip crowns :

composite. Manufacturer claims it to be Color These are commonly used Crown forms
stable, plaque resistant and matches pedo-shades. filled with composite & bonded on the tooth.
It doesn’t cause wear of opposing teeth.

However there are no long term clinical trials to

assess the durability of these crowns
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Review article Annals and Essences of Dentistry
The benefits of these crowns include third of root is left unobturated. This eventually
 Parent/patient pleasing forms the superstructure of the post. During next
 Ideal for ankylosed tooth build –ups visit, celluloid crowns will be used to build up the
 Simple to fit & trim teeth.
 Removal is fast & easy
 Easily matches natural dentition This procedure reduces operator chairtime and they
 Leaves smooth shiny surface do not require a layer of opaque material as used in
 Easy shade control with composite metal posts. The celluloid crown is filled with same
 Superior esthetic quality material used in fabricating the post, hence it
 Ideal for photo cure produces a glossy finish thereby minimizing
[11]
 Crystal clear and thin polishing.
 Large selection of size
 Easy to repair 2. Orthodontic wires shaped as Greek
alphabets like alpha, omega, theta used as
However it is technique sensitive, adequate intracanal retainers
tooth structure is required and any lapses in
patient selection, moisture and hemorrhage The core build-ups are done directly or indirectly
control, tooth preparation and resin placement over these wires.
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can lead to failure.
Mortada and King(2004) proposed this technique
c. Pedo jacket involving the placement of an omega shaped
It is a tooth colored copolyester material which stainless steel wire extension into the entrance of
is filled with resin and left on tooth after the root canal prior to restoring the crown with an
polymerization instead of being removed. It internal compomer core and an external composite
does not split, stain or crack. Crowns can be restoration. The modified omega loop is an efficient
easily trimmed with scissors. technique for the restoration of the severely
damaged anterior teeth. The ease of manipulation
Dis-advantage : and short chair-side time are further advantages of
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 Only one size is available. the technique.
 Cannot be trimmed with bur
3. Indirect composite resin crowns reinforced
d. New millenium with a fibre glass post
These crowns are made up of Lab enhanced With the introduction of new adhesive systems and
composite resin material. No long term studies restorative materials, a new approach for treating
are available regarding these crowns. severely mutilated anterior teeth is explained and
documented by clinical cases, where fiber core
e. Glastech posts are introduced into the root canals of primary
Made of Artglass, which is a polymer glass. It incisors for a distance of 2 to 3 mm. It is retained in
gives a natural feel, bondability and kindness place by flowable composite, then the coronal part
associated with composite but the esthetics and is reconstructed by a strip crown to restore the
longevity of porcelain. It is crown form. A laboratory testing of the fracture load
resistance of the restored teeth proved that this
technique significantly improved the fracture load
Color stable, wear of polymer glass is similar to resistance of composite celluloid crowns, making it
enamel, kind to opposing dentition and is a valuable procedure to consider when the coronal
plaque resistant. The unique filler materials of tooth structure is not enough to support and retain a
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microglass and silica are proposed to provide composite celluloid strip crown.
greater durability and esthetics than strip
crowns. 4.Biological posts and crowns

Restoration of Severely Decayed Tooth Biological restoration was introduced by Santos &
Bianchi in 1991. Here, used teeth from the Human
1. Crown build up using resin composite short Tooth Bank are used as natural posts & crowns.
post technique The selected tooth from the tooth bank is reshaped,
Resin composites used directly or indirectly has roots strengthened by retro filling with flowable
been an excellent choice for severely carious teeth composites and autoclaved for 30min at 121 degree
due to their adhesive bonding and esthetic centigrade and 15 lbs pressure before cementation.
appearance. The technique involves placement of
light cured resin composite in the root canal and
crown region in several steps where the cervical
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Review article Annals and Essences of Dentistry

Pedo-compu crowns
Stainless Steel Crowns

Dura Crowns
Modification of Stainless Steel Crowns

Cheng Crowns

Kinder Crowns

Pedo Pearls
NuSmmile®

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Review article Annals and Essences of Dentistry

Strip Crowns

Pedo Jacket

Orthodontics wires shapes

Glass Tech

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Review article Annals and Essences of Dentistry
The natural crowns offer esthetics as well as 7. Guelmann M, Gehring DF, Turner C. Retention
preserves natural teeth colour. The enamel also has of veneered stainless steel crowns on
physiologic wear and offer superficial smoothness replicated typodont primary incisors: an in vitro
and cervical adaptation is compatible with those of study. Pediatr Dent 2003;25:275-8.
surrounding teeth. The length of each appointment 8. Yilmaz Y, Guler C. Evaluation of different
is reduced because natural teeth are prepared sterilization and disinfection methods on
previously. Further more, the technique eliminates commercially made preformed crowns. J Indian
laboratory processing and is economical. Soc Pedod Prev Dent 2008;26:162-7.
9. Kupietzky A, Waggoner WF, Galea J. The
Although the technique is simple, it requires clinical and radiographic success of bonded
professional expertise to prepare and adapt the resin composite strip crowns for primary
natural crowns and intracanal posts. incisors. Pediatr Dent 2003;25:577-81.
10. Austinglastech.com [Internet]. Austin, TX:
Studies have shown that it is cost effective, clinician Glastech Inc.; C 2001 [Cited 2010 Feb 11].
friendly, less technique sensitive and esthetic Available from:
alternative to commercially available restorative http://www.austinglastech.com/comp.htm.
materials. 11. Mendes FM, De Benedetto MS, del Conte
Zardetto CG, Wanderley MT, Correa MS.
Other factors of concern while using biologic Resin composite restoration in primary anterior
restoration is that Universal protocol of consent, teeth using short-post technique and strip
storage and sterilization should be followed in the crowns: a case report. Quintessence Int
human tooth bank. 2004;35:689-92.
12. Mortada A, King NM. A simplified technique for
Collected samples should be scaled, polished and the restoration of severely mutilated primary
freed of soft tissues and periodontal remnants. anterior teeth. J Clin Pediatr
Pulps have to be removed and complete biological Dent. 2004;28:187-92.
preparation is to be done. 13. Sharaf AA. The application of fiber core posts
in restoring badly destroyed primary incisors. J
Teeth are then stored at 4degree centigrade in Clin Pediatr Dent. 2002;26:217-24.
HBSS with donor identification till the time of its 14. Mandrolip S. Biologic restoration of primary
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use. anterior teeth : A case report . J Indian Soc
Pedo Prev Dent 2003;21:95 -7.
CONCLUSION
Many restorative options exist for treating primary
anterior teeth. Finally the choice of restorative Corresponding Author :
technique depends upon the operator preferences, Dr. Suzan Sahana MDS
esthetic demands by the parents and child’s Sr. Lecturer, Department of Pedodontics and
behavior that affect the ultimate outcome of Preventive Dentistry,
whichever restorative material chosen. St. Joseph Dental College, Eluru. India
Pin: 534 003
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