Six Steps to Place Permanent SSCs

I hear a lot of negative information on stainless steel crowns on permanent teeth in social media. General dentists often say they cut off the crown and find mush or that the feather edge margins make it hard to prepare the tooth for an indirect restoration. While there are disadvantages stainless steel crowns on permanent teeth have advantages as well:

• Can be placed in one visit

• Protect severely broken down teeth from fracture

• Greater longevity than composite and amalgam restorations

Step 1

Complete occlusal reduction. Stainless steel crowns require about 1.5 mm of reduction. Don't forget to place a bevel on the functional cusp just as one would when preparing a permanent tooth for an indirect restoration (Buccal on mandibular teeth, lingual on maxillary teeth).

Step 2

Interproximal reduction. A flame diamond can be used to complete this step. Make sure to have a feather edge margin and be sure to check for leges sub gingivally. A ledge can prevent the stainless steel crown from fully seating. Complete caries removal as appropriate afterwards.

Step 3

Fit a crown. To obtain the best margin find the smallest crown that will almost seat. This might sound counter intuitive, but most crowns are too long in the occlusal gingival dimension and if left untrimmed can cause a periodontal problem

Step 4

Trim 2-3 mm off the gingival contour of the crown. This will remove the pre-contoured part of the crown and allow it to seat. After trimming try the crown in to ensure a good fit.

Step 5

Re-crimp the crown with band crimping pliers and smooth out the margin. This can be done with dental stones and will ensure that the crown doesn't have any sharp edges at the margin which could irritate the gingivae.

Step 6

Dry the tooth and cement the crown. Typically an RMGI or GI cement is best depending upon the situation. If moisture control is an issue a GI cement will perform better. If isolation is adequate an RMGI has been shown to have less microleakage. Proceed to cleaning up excess cement and viola! Treatment is done.

Alternatives to SSCs for Permanent Teeth

Indirect restorations are always an option. Currently crowns can be made by a dental lab, or milled in the office. One up and coming technology in the dental industry is 3D printing. A 3D printed crown that contains more than 50% zirconia can be billed as a zirconia crown, and printers and materials are advancing at light speed. Keep an eye on this technology this decade.