Stainless Steel Posterior Crowns
and Pre-Veneered Stainless Steel
Anterior Crowns in a Primary Dentition Stainless Steel Crowns

The stainless steel crown remains the workhorse of restorative care for young children, particularly for posterior teeth. It is not unusual for a stainless steel crown to last the life span of the primary tooth and exfoliate with the tooth. When a pulpotomy (removal of the coronal portion of the pulp) is performed, the crown adds strength to the tooth and prevents leakage more effectively than any other restorative material. For larger class II restorations, the crown avoids broken marginal ridges and fractures that can occur with both amalgams and composites.

Have a selection of crowns that are pre-crimped and pre-festooned. These can often be placed without any manipulation or trimming, making them a cost-effective choice for posterior teeth. While the financial outlay for a set of crowns may seem prohibitive, the crowns will soon pay for themselves.

The open-faced stainless steel crown is a happy medium between a fully veneered stainless steel crown and a stainless steel crown. In many cases when a stainless steel crown is placed, a pulpotomy is performed when the tooth has vital pulp and no radiographic or clinical signs of deterioration. In some young children, the roots may not be fully formed, precluding a pulpectomy (complete removal of the pulp).

Today, oral health professionals are moving away from formocresol owing to its toxicity and are using ferric sulfate as an alternative. The clinical technique is about the same for both, except that ferric sulfate does not need to be kept in the pulp chamber for 5 minutes.

The indications for a pulpectomy include a pulp that can be managed for hemorrhage. A continuously bleeding pulp signifies one that is dying or very inflamed and may indicate that an extraction or pulpectomy is needed. Some primary teeth need extraction. Abscess, lack of restorability due to the size and location of the caries, and when the restoration of choice is a gamble are reasons to consider extraction.

Critical to the development of a fully functional permanent dentition is the retention of the second primary molar until the first permanent molar erupts. If possible, a pulpectomy should be performed even on a second primary molar with a marginal prognosis to keep the tooth in place until the permanent first molar erupts and a functioning space maintainer can be put in place.

Photo reproduced with permission from William L. Chambers, D.D.S.

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