A Massively Underutilised Quick and Successful Adult Patient Restorative Material
As pediatric dentists, we often encounter adults with special needs or severe dental anxiety. While it's not our primary focus, we receive training in our programs to assist our exceptional colleagues, Special Needs Dentists, who are sadly all too rare. One effective treatment option for these patients is the use of permanent stainless-steel crowns, which surprisingly are underutilized in adult dentistry. I used to use them in adult patients when practicing general dentistry.
There are several situations where these crowns can be very beneficial:
Large multi-surface restoration,
Deep interproximal carious lesion margins,
Extensive decay encircling the tooth (ringbarked),
After root canal treatment when immediate crown placement is not feasible/financial,
Following a permanent tooth pulpotomy,
Cracked molars where finances preclude a crown at this time.
A large and deep carious lesion in a 17yr old patient. We were extracting #27 so we wanted to preserve the 6
Post MTA pulpotomy,which are also underutilised in permanent teeth!. You can see it has easily sealed the deep mesial margin.
Since stainless-steel crowns are relatively thin, the tooth preparation required is minimal, and their long-term prognosis is excellent (10+ years). An interesting article titled Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study - ScienceDirect provide evidence supporting their effectiveness.
Once you have placed a few stainless-steel crowns, you'll find that the entire process takes around 20 minutes. It requires minimal equipment and has a low cost, with the crowns themselves costing around $10. They are also very technique insensitive and in cases where the preparation has traumatised gingiva perfect haemostasis is not necessary (you can’t cement it with +++ blood but…)
So why aren't they used more frequently? Generally, the main reasons are a lack of training and confidence. Additionally, they may cause some gingival or periodontal irritation due to their design. However, if using these crowns allows a patient to retain a tooth that would otherwise be extracted or serves as a cost-effective medium-term restoration, it has achieved its purpose.
Deep distal carious lesion in a #46 and also close to the pulp. A SSC preparation does not require significant caries removal as it ‘seals the carious lesion in’
Post cementation, without significant caries removal and minimal prep. The mesial cement was removed shortly after!
In conclusion, we strongly encourage practitioners to consider using stainless-steel crowns not only in paediatric patients but also in appropriate cases involving adults.
Best wishes, Sarah and Tim