PAGD Keystone Explorer Fall 2021

Keystone Explorer | Fall 2021 9 Stainless steel crowns (SSC’s) are deemed to be the most durable and reliable treatment for primary molars with multi-surface caries when the restoration should survive more than two years or the child is under six years of age. 1 SSC’s are also indicated for interproximal caries extending beyond line angles, for restoration of a primary molar that is to be an abutment for a space maintainer, and following pulpotomy or pulpectomy. 2 If sedation or general anesthesia are necessary to treat a child with extensive caries, stainless steel crowns have been shown to reduce the risk of repeated sedation or general anesthesia. In a study by Azadani et al ., probability of surviv- al for SSC’s was 98% by 84 months after general anesthesia. Preventive or restorative treatment other than SSC’s resulted in recurrent caries in a substantial number of patients. 3 Caries risk status, particularly with high-risk children, should be considered when making decisions regarding a treatment plan in the primary dentition. Both the distal sur- face of the primary second molar and the occlusal surface of the first permanent molar impact the incidence of caries on the mesial surface of the first permanent molar. 4 Once the distal surface of the second primary molar and the mesial surface of the first permanent molar are in contact, the mesial surface of the first permanent molar becomes a susceptible surface for carious involvement due to spread of caries from distal surface of the second primary molar. For this reason, a stainless steel crown may be indicated when restoring the mesial surface of the second primary molar in a child with occlusal caries on the first perma- nent and with high caries risk or severe early childhood caries. Additionally, recurrent caries around the margins of a disto-occlusal composite resin restoration in a second primary molar may result in mesial caries in the adjacent first permanent molar. Armamentarium » Mirror & Explorer » Pre-contoured/pre-crimped SSC’s » Local anesthesia » Rubber dam with slit technique » #7, 8, or 8A rubber dam clamp lighted with floss for second primary molars with the first permanent molar unerupted » #14 or 14A rubber dam clamp for first perma- nent molar Crown Selection » Pre-contoured SSC’s require no buccal or lingual tooth reduction. » If new to this procedure, measure the mesio-distal width of the primary molar with a millimeter ruler or Boley gauge to help in determining the crown size. Size 4 is the most common size. Full-Coverage Restoration for Primary Molars Jane A. Soxman, DDS Diplomate American Board of Pediatric Dentistry dentistry issues Q