Use of standard crowns in pediatric dentistry

The use of standard dental crowns in pediatric dentistry dates back to the fifties of the last century, but in Ukraine this focus area began to develop actively only recently.

These crowns are named standard because they are premade and there are variations of the sizes of such crowns (photo 1). This allows the pediatric dentist to choose the right version of the dental crown without making dental impressions (as in adult dentistry) and laboratory stages (photo 2). Such a crown can be placed on a kid’s tooth immediately during dental treatment in the clinic.

Photo 1 Standard metal dental crowns are used to restore lost hard tissues of the lateral teeth. They have 6 sizes, which makes it possible to choose the necessary crown for each clinical situation

Photo 2 Standard aesthetic dental crowns have different sizes, which helps to achieve the correct function of the tooth and top-notch aesthetics

While standard metal crowns (photo 3) have been used in the treatment of caries and its complications, the use of standard aesthetic dental crowns in pediatric dentistry has only begun to develop over the past few years.

Metal dental crown. The shape and dimensions of the metal crown are selected in such a way that you can quickly select and install the desired crown

The most common aesthetic standard crowns are metal crowns, coated with a composite (strong and durable material, photo 4), zirconium and composite crowns. Dentists of our pediatric dentistry department always keep up to date in order to provide qualified assistance to our small visitors, so we could not get around this important topic.

Metal-composite dental crown has a metal base, externally coated with a composite material

In the pediatric dentistry department of the “Dubnova Clinic “STOMATOLOGiYa” we actively use both standard metal and standard aesthetic crowns (photo 5) to treat the effects of caries in kids and to preserve kid’s teeth. Also, we actively share our experience on this topic and conduct training seminars and practical master classes, dedicated to this topic for pediatric dentists from all over Ukraine (photo 6).

Zirconium dental crown is made of zirconium dioxide – very durable and aesthetic material

Doctors of the pediatric department of “Dubnova Clinic “STOMATOLOGiYa” successfully mastered the methods of working with metal and aesthetic dental crowns and share their experience with kid’s dentists in Ukraine and abroad

Crowns for kids? Yes!

Many parents, when it comes to the use of a dental crown for dental treatment of his/her kid, are genuinely surprised, because they do not even imagine that its use is possible for children. First, parents believe that crowns are the exclusive prerogative of adults, and secondly, they sincerely believe that the crown is not needed at all because the first teeth will fall out and that’s why it’s a waste of time, money and efforts of parents and children. Or does it?

Dental crowns are successfully used for dental treatment not only for adults but also for children. They help to preserve the decayed first teeth before the appearance of permanent teeth. After all, the temporary tooth should function in the oral cavity for 5 to 10 years, providing chewing, shaping of speech, aesthetics and maintaining a place for the permanent tooth (photo 7).

Dental crown, which has been functioning successfully for more than 5 years

Why is the crown better than the fillings? Why is necessary to put a crown? Why I not possible just put a filling?

Both for the dental crown and for the filling (restoration), there are peculiar indications. However, due to the fact that for a long time the crowns were hard to get in Ukraine, pediatric dentists had to put fillings where indications for the installation of crowns had long existed. Both the fillings and dental crowns are good when used according to the indications; however, there are indications for the use of the crowns.

It is recommended to apply the crowns, in particular, in the following situations:

– When more than 50% of hard tooth tissues are lost. In this case, the size of the filling exceeds the volume of tissues of the tooth itself that have remained, that significantly increases the probability of split-off or full loss of such a filling.

– When caries affected several surfaces of the tooth. In this situation, restoration of the tooth with the use of a crown is also indicated, since it is difficult or impossible to isolate the tooth from saliva for a high-quality tooth filling (photo 8).

Using a metal dental crown under condition of a loss of more than 50% of hard tissues on several surfaces of the tooth

A tooth decayed with caries

The condition of the tooth after preparation of infected tissues

Restoring the tooth with a metal dental crown (teeth with a smaller trauma volume are restored with composite material)

– Teeth, in which the endodontic treatment was performed (treatment of the tooth canals), that is, partial or complete removal of the tooth pulp, are recommended to cover with a crown! Why is it? One of the functions of the pulp of the tooth is to ensure the supply of hard tooth tissues. Therefore, when according to the indications the hard tissues are necessary to remove, the tooth becomes more fragile, and with the background of a significant loss of hard tissues, the probability of its split-off increases significantly. Therefore, when your kid’s dentist recommends installing a crown on such a tooth, then he/she does everything right! In this case, the crown is the best method of treatment, because when the crown is set, split-off becomes impossible in the tooth, in which partial or complete removal of the pulp has been performed (photo 9). A qualitatively treated temporary tooth is one of the important factors of permanent tooth’s health!

The condition of the tooth before the treatment

The condition of the tooth after removal of carious tissues, partial removal of pulp caused by the inflammatory process (most hard tooth tissues are lost). Isolation of the working field is carried out with the help of the system “rubberdam”

Restoration of lost hard tooth tissues with zirconium crown (adjacent tooth is restored with composite material)

– In cases of difficult oral hygiene. There are situations when a kid or his parents cannot properly brush the kid’s teeth. This may be due to objective factors (difficult to open the mouth, etc.) (photo 10) and subjective factors (kid’s behavior, inability to properly concentrate his attention, etc.). It maybe also difficult to clean some parts of the tooth (teeth). Materials used for fillings quickly lose the ability to fix to the tooth in areas of inadequate hygiene, causing secondary caries. The crown covers the tooth completely; therefore, the probability of secondary caries is cancelled out. Of particular importance is the use of dental crowns for kids with special needs, in which individual hygiene is not always possible at adequate level.

Aesthetic zirconium crowns for the front teeth

Before the start of treatment: the kid is 1.8 years old, the front teeth are significantly destroyed, one tooth is broken off due to the caries, hygiene (a significant amount of plaque) is difficult. Due to the considerable volume of treatment, the young age of the patient and the lack of cooperativeness, the treatment was performed under conditions of medical sleep

The state of teeth after preparation of infected tissues and filling of root canals caused by inflammation of the pulp

Immediately after the placement of the dental crowns (gums are slightly affected)

After 2 weeks on a check-up – an excellent condition of dental crowns and gums

– Coating teeth with crowns is recommended in case of anomalies of hard tissues of teeth, when it is problematic to restore teeth by filling materials (photo 11).

Use of metal dental crowns under conditions of anomalies of teeth hard tissues development

Dentinogenesis imperfecta (Stainton-Capdepont syndrome) is a hereditary genetic anomaly of hard tooth tissues. The hard tissues of the teeth are erased and teeth split off much faster than usual

Restoration of the lateral group of teeth with metal crowns (the front teeth are restored with composite materials). Without proper treatment, such teeth are erased up to the gums for 1-2 years. However, thanks to the crown coating, they will function successfully till the physiological change to permanent teeth

– The advantage of using standard crowns in pediatric dentistry, in comparison with restorations / fillings, is the fact that after restoration of one surface by a filling, caries can also appear on the other four surfaces of the tooth, and each of them must be filled again. However, when the crown is installed, it once and forever covers all surfaces of the tooth and makes it impossible for microorganisms to access the tissues of the tooth, thus blocking the further possibility of the appearance of caries in this tooth.

Is it required to grind adjacent teeth in order to install the crown?

Crowns in pediatric dentistry are installed exclusively on the compromised tooth and in no way affect neighboring ones. Thus, it is not necessary to grind neighboring teeth.

How will the tooth fall out with the crown?

The standard crown covers only the outer, crown part of the tooth, not touching its root part; therefore it does not affect the resorption of the tooth root and the natural change of teeth in any way. Thus, the root of the temporary tooth dissolves under the influence of the rudiment of the permanent tooth, which comes out, and the crown falls out together with the part of the tooth that has remained. Therefore, the tooth, covered with a crown, falls out like any temporary tooth (photo 12).

Physiological change of the crown to a permanent tooth

Dental crown in the oral cavity

A tooth crown that fell out

Permanent tooth in place where the tooth crown was installed

Can the crown fall out (decement)? And what is the next step in this situation?

Crown decementation appears extremely rare. The prerequisites for this situation are the complex conditions of crown’s setting, namely: the complex isolation of the tooth before setting the crown, the significant loss of hard tissues, etc. In this case, the dentist must create conditions for reliable fixation and cement the dental crown again.

In the practice of our pediatric dentistry, there were single case reports (2 cases in 7 years) of crown being decemented. In both cases, this was due to a severely compromised tooth, when we did not have the opportunity to fill it, and there was a choice: either crown or a removal. After crown individualization (adjusting the crown with special tools) and re-fixing such crowns, they continued to successfully perform their functions, and, thus, we managed to avoid the removal of teeth that had to last more than 4 years.

Can the dental crown break down and what to do in a such situation?

Metal crowns cannot break. Under the condition of the influence of factors of considerable force, such as, for example, trauma, the aesthetic crowns may be split off. In such a situation, the dentist can correct the tooth crown with restorative materials or replace it.

Can caries develop under the crown?

With properly prepared tooth, correctly selected and installed crown, the development of caries is impossible.

How should we brush the teeth after setting the crown?

After setting the crown, dental care is no different from the usual care of teeth. However, we must remember that although tooth decay does not occur on the crown, it can occur on the teeth adjacent to the crown. With insufficient hygiene, dental plaque can accumulate on the crown, as well as on the teeth themselves. This will not affect the tooth under the crown, but will provoke inflammation in the gums. Therefore, proper brushing of teeth twice a day is mandatory!

What sense of discomfort may the kid feel after the crown setting?

When preparing the tooth for setting the crown, the tooth is treated at the gum or (to a slight depth) under it. Such preparation, as a rule, is carried out under local anesthesia, therefore, after the action of the local anesthetic passes, there may be discomfort in this area, which completely passes in 1-2 days. Another place of temporary discomfort may be the place of occlusion. Since the crown is standard and not adjusted “by bite”, at first, the kid may feel uncomfortable to close his/her teeth. But, depending on the number of installed dental crowns, the situation is normalized in the period from one to several days.

Can be a crown set without anesthesia (medical sleep)?

Dental crowns can be installed both in conditions of medical sleep (under anesthesia), and in conditions of local anesthesia (photo 13).

Use of four metal-composite dental crowns without the medical sleep, only under local anesthesia

Before the start of treatment: the kid is 3 years old, teeth are almost completely destroyed

Restoration of teeth with metal-composite crowns (external composite coating)

Inner surface of metal-composite dental crowns

Excellent condition of dental crowns and surrounding gums on control examination after 14 days

However, when we work in conditions of medical sleep, we often opt for crowns, because children, whose teeth are significantly destroyed by caries or they have significant difficulties with individual hygiene (or both), are treated more often in a medical sleep. And when setting the crown, the probability of a tooth split off or re-occurrence of caries in it is reduced to a minimum. At the same time in the filled teeth caries can occur on other surfaces of the teeth, and this sometimes happens so quickly that we still cannot work with the kid under conditions of local anesthesia alone and have to undergo a second treatment in a sleep. When we set the crown on the tooth, the probability of caries in this tooth is reduced to zero (you can find out more about the treatment in conditions of medical sleep from the materials on our YouTube YouTube channel).

Which crowns are better: aesthetic or metallic? What material crowns are made of?

Each dental crown has its own indications. Metal crowns are not clearly indicated for the aesthetic area (smile zone), since they can significantly affect the aesthetics of the smile and the kid’s self-esteem.

Metal crowns are made of a chromium-nickel alloy, which is widely used in dentistry for the manufacture of various designs. They are cheaper and take less time to prepare the tooth. Contraindication to the use of metal crowns is an allergy to its components (nickel or chromium). However, the frequency of allergy to nickel is not more than 0.1%, and during the use of dental crowns in our clinic, no case of allergy to the material of the crown was found.

Aesthetic crowns, in addition to the advantages inherent in metal, have a better aesthetic appearance (after all, they do not visually differ from ordinary teeth), and can be used both in the lateral and in the frontal area to restore lost hard tissues of teeth. In addition, the aesthetic crowns that we most often use in our dental clinic are made of zirconia – a special material that today has one of the highest degrees of biocompatibility and the minimum possibility of accumulating plaque on the crown. However, they are more expensive, compared to metal crowns.

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