Pediatric Dental Crowns: Indications, Benefits, and Long-Term Success

Pediatric dental crowns are widely used in the restoration of primary teeth with extensive decay, developmental defects, or after pulp therapy.

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This article reviews current evidence regarding their indications, benefits, and long-term success, focusing on stainless steel crowns (SSCs), zirconia crowns, and recent advances.

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✅ Introduction
Restoring severely decayed primary teeth poses a significant challenge in pediatric dentistry. Conventional fillings often fail due to limited durability and the complexity of managing caries in children. Pediatric dental crowns, particularly stainless steel and zirconia crowns, provide a reliable restorative option. Their role in maintaining arch integrity, mastication, and aesthetics has made them a cornerstone in modern pediatric restorative dentistry.

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✅ Indications

° Extensive caries affecting multiple tooth surfaces.
° After pulpotomy or pulpectomy procedures.
° Developmental anomalies such as amelogenesis imperfecta or dentinogenesis imperfecta.
° Fractured teeth requiring coverage.
° Cases where behavior management limits frequent re-interventions.

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✅ Types of Pediatric Crowns

° Stainless Steel Crowns (SSC): Gold standard for posterior teeth due to durability and cost-effectiveness.
° Zirconia Crowns: Increasingly used for anterior and posterior restorations, offering superior aesthetics.
° Resin-veneered Crowns: Intermediate option balancing aesthetics and functionality.

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✅ Benefits

° Provide full coverage protection against recurrent caries.
° High survival rates in comparison to amalgam or composite restorations.
° Improve chewing function and preserve arch length.
° Aesthetic options (zirconia) enhance parental and patient satisfaction.

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✅ Long-Term Success

° Survival rates: SSCs demonstrate over 90% success rates at 5 years (Innes et al., 2015).
° Zirconia crowns: Show comparable survival with better aesthetics but require precise tooth preparation.
° Parental satisfaction: Significantly higher for zirconia crowns due to aesthetics (Walia et al., 2014).

📊 Tabla comparativa: Pediatric Dental Crowns

Aspecto	Ventajas	Limitaciones
Stainless Steel Crowns (SSC)	High durability, cost-effective, >90% survival	Poor aesthetics, metallic appearance
Zirconia Crowns	Superior aesthetics, high parental satisfaction, biocompatible	Require extensive tooth preparation, higher cost
Resin-Veneered Crowns	Balance between cost and aesthetics	Prone to veneer fracture and wear
Long-Term Outcomes	High survival rates, preservation of arch integrity	Technique-sensitive, dependent on case selection

💬 Discussion
The literature strongly supports the use of pediatric crowns as a superior restorative option for severely compromised primary teeth. While stainless steel crowns remain the most cost-effective and durable, zirconia crowns address increasing parental demands for aesthetics. However, zirconia requires more aggressive tooth reduction, which may limit its indications in certain cases.
The long-term success of pediatric crowns is linked to proper case selection, clinical technique, and patient cooperation. Advances in adhesive dentistry and biomimetic materials may further enhance restorative outcomes, but crowns continue to hold a key role in comprehensive pediatric oral care.

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✍️ Conclusion
Pediatric dental crowns are the treatment of choice for extensively damaged primary teeth, providing excellent durability, functional preservation, and, with modern options, improved aesthetics. Both stainless steel and zirconia crowns demonstrate high long-term survival rates. Future research should focus on minimally invasive approaches that combine aesthetics with biological preservation.

📝 Reference

✔ Innes, N. P., Ricketts, D., & Evans, D. J. (2015). Preformed metal crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2015(12), CD005512. https://doi.org/10.1002/14651858.CD005512.pub3
✔ Walia, T., Salami, A. A., Bashiri, R., Hamoodi, O. M., & Rashid, F. (2014). A randomized controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth. European Journal of Paediatric Dentistry, 15(2), 113–118.
✔ Choi, S. C., Park, J. H., Kim, J. H., & Shin, Y. (2018). Clinical outcomes of preformed zirconia crowns in primary molars: A 24-month prospective study. Journal of Dentistry for Children, 85(3), 107–112.

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Non-invasive options such as fluoride therapies, sealants, and behaviorally guided oral hygiene strategies form the foundation of this model, while minimally invasive techniques, including selective caries removal or atraumatic restorative treatments, provide solutions when intervention is required.

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By reducing patient anxiety, improving cooperation, and safeguarding dental development, minimally invasive dentistry not only addresses disease but also empowers families with knowledge and practices that promote long-term oral health.

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Treatment planning for full mouth rehabilitation in children is a dynamic process that balances multiple considerations. Current evidence highlights that dental caries, the leading cause of extensive rehabilitation needs, arises from multifactorial influences such as diet, oral hygiene, microbial activity, and socioeconomic factors.

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Addressing these complexities demands more than standardized care; it requires an evidence-based framework adapted to each child’s risk profile and clinical condition.

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Pediatric dentists must also integrate their professional expertise, assessing which restorative techniques, preventive measures, and behavioral strategies best align with long-term success.

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Equally important are the preferences and expectations of families, as their involvement is central to adherence and outcomes. A carefully structured plan not only resolves the immediate dental disease but also establishes healthier oral environments, reduces the likelihood of relapse, and supports the child’s overall well-being.

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Hall Technique vs Conventional Stainless Steel Crowns in Pediatric Dentistry: Effectiveness, Pros and Cons

Stainless steel crowns (SSC) are the gold standard for restoring extensively carious primary molars. The conventional technique requires caries removal, anesthesia, and tooth preparation.

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In contrast, the Hall Technique seals caries under a preformed metal crown without local anesthesia, tooth preparation, or caries removal, aligning with the principles of minimally invasive dentistry.

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✅ Advantages and Disadvantages

1. Hall Technique
➤ Advantages
° High success rates (~94–97% at medium-term follow-up).
° No anesthesia, drilling, or caries removal, reducing anxiety in pediatric patients.
° Shorter chair time (4–5 minutes vs ~28 minutes for conventional SSCs).
° Well accepted by children and parents.
° Spontaneous occlusal adjustment within weeks.
➤ Disadvantages
° Initial occlusal vertical dimension increase (resolves in 2–30 days).
° Not suitable in advanced pulpal involvement or extensive root resorption.
° Aesthetic limitations (visible metal).
° Requires orthodontic separators in tight contacts, which may cause discomfort.

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2. Conventional Stainless Steel Crowns (SSC)
➤ Advantages
° Long clinical track record, widely taught in dental curricula.
° Effective in a broad range of clinical cases.
➤ Disadvantages
° Invasive: requires anesthesia, tooth preparation, and caries removal.
° More time-consuming (~28 minutes per case).
° Patient discomfort and possible trauma.
° Comparable survival to Hall but requires more resources

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💬 Discussion
The Hall Technique demonstrates comparable or superior survival rates to conventional SSCs in primary molars, with additional benefits of reduced chair time, less invasiveness, and higher patient acceptance. Although initial occlusal changes and esthetics remain challenges, evidence shows these issues resolve or are clinically acceptable. The Hall Technique is especially valuable in anxious children, special needs patients, or resource-limited settings.

✍️Conclusion
Both Hall and conventional SSC techniques are effective for managing extensively carious primary molars. However, the Hall Technique offers a minimally invasive, patient-friendly alternative with high success rates and reduced treatment burden. Proper case selection remains essential to ensure long-term success.

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📚 References

✔ Altoukhi, D. H., & El-Housseiny, A. A. (2020). Hall technique for carious primary molars: A review of the literature. Dentistry Journal, 8(2), 35. https://doi.org/10.3390/dj8020035

✔ Innes, N. P. T., Ricketts, D., Chong, L. Y., Keightley, A. J., Lamont, T., & Santamaria, R. M. (2019). Preformed crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2019(5), CD005512. https://doi.org/10.1002/14651858.CD005512.pub3

✔ Ludwig, K. H., Fontana, M., Vinson, L. A., Platt, J. A., & Dean, J. A. (2014). The success of stainless steel crowns placed with the Hall technique. Journal of the American Dental Association, 145(12), 1248–1253. https://doi.org/10.14219/jada.2014.95

✔ Elamin, F., Abdelazeem, N., & Honkala, E. (2019). Comparison of Hall technique and conventional stainless steel crown techniques for primary molars: A randomized controlled trial. European Archives of Paediatric Dentistry, 20(5), 467–474. https://doi.org/10.1007/s40368-019-00421-3

✔ Ayedun, O. S., Folayan, M. O., & Oyedele, T. A. (2021). Comparison of the treatment outcomes of the Hall technique and conventional stainless steel crown technique. Nigerian Journal of Clinical Practice, 24(4), 548–554. https://doi.org/10.4103/njcp.njcp_507_19

✔ Badar, S. B., Tabassum, S., & Khan, F. R. (2019). Effectiveness of Hall technique for carious primary molars: A meta-analysis. International Journal of Clinical Pediatric Dentistry, 12(2), 132–138. https://doi.org/10.5005/jp-journals-10005-1622

✔ Hu, S. (2022). Hall technique for managing carious primary molars: A systematic review. Journal of Stomatology, Oral and Maxillofacial Surgery, 123(6), 581–588. https://doi.org/10.1016/j.jormas.2022.01.003

Herkar, P. P., Karkera, R., & Thomas, A. (2022). A comparative study of stress distribution in primary molars restored with Hall and conventional SSC techniques using finite element analysis. Journal of Pediatric Dentistry, 40(3), 205–212. https://doi.org/10.4103/jpd.jpd_25_22

✔ MedRxiv. (2025, May 19). Comparative survival of Hall vs conventional preformed metal crowns in primary molars. MedRxiv. https://doi.org/10.1101/2025.05.18.25327863

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Stainless Steel Crowns for Kids: When and Why They’re the Best Option

Stainless steel crowns (SSCs) are one of the most reliable restorations used in pediatric dentistry, especially for baby molars that have severe decay or have undergone pulp therapy.

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First introduced in the 1950s, they are still widely used because they are strong, affordable, and long-lasting—often outperforming white fillings in baby teeth.

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✅ When Are Stainless Steel Crowns Used in Children?
Pediatric dentists commonly use SSCs when:

° A baby tooth has large cavities that can’t be fixed with a regular filling
° The tooth has been treated with a pulpotomy or pulpectomy
° The enamel is weak due to conditions like enamel hypoplasia or molar-incisor hypomineralization (MIH)
° The tooth has fractured due to trauma
° The child is at high risk of cavities or has special healthcare needs

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✅ Benefits of Stainless Steel Crowns for Baby Teeth

° Long-lasting protection (often until the tooth naturally falls out)
° Full coverage and excellent seal against bacteria
° Quick and easy placement in a single visit
° Ideal for young children or those who have trouble cooperating
° Lower cost than most other restorative options

✅ How Pediatric Dentists Place a Stainless Steel Crown

1. Examine and diagnose the tooth
2. Choose the correct crown size
3. Reduce the biting surface and sides of the tooth
4. Try in the crown to ensure a proper fit
5. Cement it using glass ionomer cement
6. Check the bite and remove any excess cement

The entire process can often be done in one appointment, which is especially helpful for children with limited patience or dental anxiety.

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✅ Why Not Just Do a Filling?

White fillings (composite) or silver fillings (amalgam) may work for small cavities, but they often fail in baby teeth with major decay. Stainless steel crowns are stronger, more protective, and have a much lower failure rate—especially when the child is at high risk for future cavities.
While some parents may prefer tooth-colored crowns, research shows that SSCs have a success rate of over 90%, even after several years. Esthetic crowns like zirconia are more expensive, and not always ideal for very young or uncooperative children.

💡 Conclusion

Stainless steel crowns remain the gold standard for restoring primary molars with major damage. They offer reliable, long-term protection, are cost-effective, and reduce the need for future dental work.
If your child needs treatment for a decayed or weakened baby tooth, talk to your pediatric dentist about whether a stainless steel crown is the right option. In many cases, it’s the best way to keep their smile healthy and pain-free until the adult teeth come in.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Clinical Practice Guidelines: Restorative Dentistry. Reference Manual, 45(6), 372–380. https://www.aapd.org/research/oral-health-policies--recommendations/

✔ Lynch, C. D., O'Sullivan, V. R., & McConnell, R. J. (2020). Success and survival of stainless steel crowns placed in primary molars: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 30(3), 212–222. https://doi.org/10.1111/ipd.12612

✔ Santos, J. M., Diniz, M. B., Oliveira, B. H., & Braga, M. M. (2021). Longevity of restorations in primary teeth: A systematic review and meta-analysis. Pediatric Dentistry, 43(1), 16–24. https://www.aapd.org

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Zirconia crowns in pediatric dentistry: Clinical considerations and step-by-step procedure

Early childhood caries destroys children's dental tissue, especially the upper incisors, putting the patient's aesthetics, chewing, phonation, and social development at risk.

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Rajesh Hemant Bariker, Jorge Casián-Adem, Ivonne Segovia. Clinical considerations for preformed zirconia crowns in early childhood caries: A case series and review of literature. Contemp Pediatr Dent 2022:3(1):24-34

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Dental Bridges: Step by Step Procedure

When one or several teeth are lost due to trauma or advanced caries, a series of serious consequences opens up that puts the patient's occlusion, chewing and aesthetics at risk.

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Hall Technique Procedure Manual: Advantages, Disadvantages, Step-by-Step Procedure

Caries is an infectious, multifactorial and most prevalent disease that affects the dental surface of the primary and permanent dentition. It is important to rehabilitate the affected teeth to avoid serious consequences in the development of the dentition.

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The Hall technique is a safe and effective procedure that prevents the advance of dental caries in primary teeth. One of its great advantages is its low cost and little prior preparation.

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We share a manual on the Hall technique, detailing step by step its preparation and the justification for its use in controlling dental caries in primary dentition.

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The Hall Technique A minimal intervention, child centred approach to managing the carious primary molar. Text copyright Nicola Innes, Dafydd Evans, Matthew Stewart, Alex Keightley. University of Dundee. Edition 4: 01.07.15

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Stainless steel crowns: Minimally invasive technique - Benefits and advantages

Stainless steel crowns are used for the restoration of primary teeth that have been affected by advanced caries or by a fracture that compromises a large part of the dental tissue, or in cases such as Molar Incisor Hypomineralization.

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Stainless steel crowns are chosen for their ease of adaptation, simple technique, and long life, as well as their low cost compared to other restorative means.

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Molar incisor hypomineralization: Definition, diagnosis and clinical management

Molar incisor hypomineralization is a development defect of dental enamel, and affects the aesthetics of the tooth and generates sensitivity and a high degree of enamel fracture, in addition to a high risk of caries.

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The molar or incisor affected by hypomineralization presents a white/yellow color, and with an enamel susceptible to fracture. There are mild and severe cases, which is why an early diagnosis is important to avoid tooth loss.

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We share an article that teaches us what is the clinical management of molar incisor hypomineralization (MIH), differential diagnosis and treatment in mild and severe cases in children.

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Molar Incisor Hypomineralization: Minimally Invasive Treatments - Step by Step

The tooth affected by molar incisor hypomineralization has a porous appearance with brown, yellow and opaque white stains. It is of unknown etiology and the patient is affected in aesthetics.

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The patient may present sensitivity, and an accelerated wear of the dental structure. The risk of caries is high and must be treated to prevent tooth loss.

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We share the management protocol and techniques of minimally invasive treatments that exist for molar incisor hypomineralization.

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Fragelli, Camila & Souza, Juliana & Jeremias, Fabiano & Cordeiro, Rita & Santos-Pinto, Lourdes. (2015). Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth. Brazilian oral research.

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Molar-Incisor Hypomineralization: Clinical Manifestations and Treatment

Clinically, Molar Incisor Hypomineralization is characterized by presenting a dental piece with an enamel that fractures easily and of various colors that vary between yellow, brown and white. The causes are unknown but it is related to external and pharmacological factors.

The patient presents sensitivity, pain on chewing, high risk of caries. Other abnormalities such as fluorosis and enamel hypoplasia should be ruled out.

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Alternative for the rehabilitation of pediatric patients with early childhood caries

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Stainless Steel Crowns: Types, procedure and techniques

Oral rehabilitation in a pediatric patient becomes a challenge for the pediatric dentist, because he must take into account the management of the patient's behavior and perform a treatment that takes the least number of appointments.

Steel crowns become the best alternative to restore primary molars that are affected by advanced caries until their natural exfoliation. For anterior teeth, the use of resins or zirconia crowns is recommended.

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We share the benefits, types of crowns, procedures and techniques of stainless steel crowns for rehabilitation in pediatric dentistry.

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Indications for Hall technique usage in pediatric dentistry

Steel crowns in pediatric dentistry are used when the dental tissue is seriously affected by advanced caries or dental trauma. The procedure is simple and inexpensive, making it an excellent restoration option.

The Hall technique is a minimally invasive technique that controls the progression of caries, making it a much simpler procedure with less preparation.

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We share a complete article on the indications and benefits of using steel crowns and the hall technique in pediatric dentistry.

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Hall technique: Complete information for the treatment of carious primary molars

👉 READ AND DOWNLOAD "Indications for Hall technique usage in pediatric dentistry" IN FULL IN PDF👈

Milena Todorova Georgieva. Indications for use of preformed crowns in pediatric dentistry. MedInform ISSUE 2, 2016.

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How to achieve a correct marginal adaptation of steel crowns in pediatric dentistry? - Tips for a good finish

Stainless steel crowns are widely used in pediatric dentistry for the restoration of extensively damaged primary teeth, particularly after pulpotomies or pulpectomies.

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One of the most important determinants of their longevity is the quality of the marginal adaptation. A poor fit can result in microleakage, plaque accumulation, and secondary caries. Therefore, understanding proper techniques for crown selection, adjustment, and cementation is essential.

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✅ Crown Selection
Proper sizing is the foundation for good adaptation. The crown should cover the entire tooth without overextending subgingivally. Undersized crowns can cause open margins, while oversized ones may irritate gingival tissues.

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✅ Tooth Preparation
Minimal tooth reduction is recommended: occlusal reduction of 1–1.5 mm and interproximal slicing to ensure passive crown seating. The feather-edge finish line helps avoid overextension and improves marginal fit.

✅ Crown Trimming and Contouring
After selection, the crown’s cervical margin may require trimming with crown scissors. Following trimming, contouring pliers are used to replicate the natural tooth anatomy. Proper contouring improves mechanical retention and ensures marginal adaptation.

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PDF 🔽 Hall technique: Complete information for the treatment of carious primary molars ... The objective of the article is to provide adequate information on the Hall technique, indications, contraindications, disadvantages, and the cost-effectiveness of this procedure.

✅ Crimping
Crimping is one of the most critical steps. Using crimping pliers, the cervical third of the crown is adapted to provide a tight seal against the tooth. Correct crimping prevents leakage and enhances retention.

✅ Cementation Technique
Glass ionomer cement is the material of choice due to its fluoride release and biocompatibility. Excess cement must be removed to prevent plaque retention and gingival irritation.

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💬 Discussion
Recent studies emphasize that the marginal adaptation of SSCs directly affects clinical outcomes. Poorly adapted margins increase the risk of gingival inflammation, caries recurrence, and premature failure of the restoration. Conversely, crowns with precise marginal adaptation show excellent long-term survival rates, often lasting until natural exfoliation of the tooth. Advances in pediatric restorative techniques suggest that proper training in trimming, contouring, and crimping is indispensable. Additionally, digital tools for measuring marginal gaps may play a role in future clinical protocols, although conventional methods remain the gold standard.

✍️ Conclusion
Achieving correct marginal adaptation of stainless steel crowns in pediatric dentistry requires attention to detail in every clinical step: proper tooth preparation, careful crown selection, precise trimming and contouring, and effective crimping. When performed correctly, these procedures ensure long-term success, reduced complications, and improved oral health outcomes in children.

📊 Table 1: Clinical Tips for Correct Marginal Adaptation of Stainless Steel Crowns

Step	Common Errors	Practical Tip
Crown selection	Oversized or undersized crown	Choose crown that covers the tooth snugly without gingival impingement
Tooth preparation	Excessive or insufficient reduction	Perform 1–1.5 mm occlusal reduction with feather-edge finish
Trimming and contouring	Sharp, uneven, or rough margins	Trim smoothly and use contouring pliers to replicate natural anatomy
Crimping	Loose cervical adaptation	Crimp cervical third firmly for a tight marginal seal
Cementation	Excess cement left in sulcus	Use glass ionomer and remove all excess cement before setting

📚 References

✔ Randall, R. C. (2002). Preformed metal crowns for primary and permanent molar teeth: Review of the literature. Pediatric Dentistry, 24(5), 489–500.

✔ Seale, N. S., & Randall, R. (2015). The use of stainless steel crowns: A systematic literature review. Pediatric Dentistry, 37(2), 145–160.

✔ Chadwick, B. L., & Evans, D. J. (2010). Restoration of primary molars with preformed metal crowns: A literature review. Journal of Dentistry, 38(1), 2–11. https://doi.org/10.1016/j.jdent.2009.09.005

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Esthetic Options for Anterior Primary Teeth - Characteristics

When caries seriously affects a primary molar, we can use stainless steel crowns that meet the retention and resistance requirements, that way we do not lose the occlusion.

But when the upper incisors are affected, we must take into account aesthetics when rehabilitating them. In pediatric dentistry, there are suitable options for the rehabilitation of upper incisors that meet all functional and aesthetic requirements.

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We share the review of aesthetic crowns in pediatric dentistry, detailing their advantages, indications, characteristics and procedure.

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Anterior dental esthetics in primary teeth - Oral Rehabilitation

👉 READ AND DOWNLOAD "Esthetic options for anterior primary teeth - Characteristics" IN FULL IN PDF👈

Gaurav Kumar Mittal, Aviral Verma, Hansika Pahuja, Shashank Agarwal, Himani Tomar. Esthetic crowns in pediatric dentistry: a review. International Journal of Contemporary Medical Research 2016;3(5):1280-1282.

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