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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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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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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We share the benefits and advantages of stainless steel crowns in the restoration of primary teeth affected by advanced caries.

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Dr. Katie Peterson. Stainless steel crowns for restoration of primary teeth: a minimally invasive, time-saving technique.

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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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👉 ARTICLE 01: READ AND DOWNLOAD "Stainless Steel Crowns in Pediatric Dentistry: A Review Article" IN FULL IN PDF👈

Dr. Vivek Mehta. Stainless Steel Crowns in Pediatric Dentistry : A Review Article. 4th Anniversary Issue | Heal Talk | September-October 2012 | Volume 05 | Issue 01

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Arunima, Ahuja V. Crowns for paediatric teeth: Stainless steel crown. J Dent Panacea 2021;3(1):20-25.

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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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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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✅ 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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Why do stainless steel crowns fail?

When primary molars lose a lot of dental tissue due to extensive caries or trauma, it is necessary to rehabilitate them with preformed steel crowns, which have a high success rate.

Stainless steel crowns are placed in an easy-to-perform, one-appointment procedure and are inexpensive. There are cases of failure that are the reason for this study.

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We share a study that analyzes the causes and reasons for the failure of stainless steel crowns in pediatric dentistry, taking into account clinical analyzes and data in the literature.

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Prakash AS (2020) Crowns in pediatric dentistry –A Review on the failures. Oral Health Care 5: DOI: 10.15761/OHC.1000193.

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Stainless Steel Crowns: Adaptation and installation - Step by step

Steel crowns in pediatric dentistry are a method of restoring primary teeth that are severely affected by caries or dental trauma, in this way natural exfoliation is expected.

Steel crowns are the most used for their easy adaptation, installation and low cost. Currently, the Hall technique is used, which simplifies the procedure for installing metal crowns.

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The video that we share teaches us everything related to steel crowns, advantages, disadvantages, and how to select the appropriate crown. It also teaches us the step-by-step adaptation and installation of steel crowns in pediatric dentistry.

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Modified Hall technique in hypomineralized molar

Enamel hypomineralization is a developmental defect, it does not have a defined cause although it is related to systemic or environmental alterations during the first three years of life.

Molars with hypomineralized enamel are susceptible to erosion and caries. The rehabilitation of the molars is necessary to avoid early tooth loss, and in this case a steel crown was placed with the modified Hall technique.

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We share the management of severely hypomineralized molars using the modified Hall technique, indicating its advantages, objectives and the step-by-step process.

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Quintero Y, Leite de Farias A, Restrepo M, Santos-Pinto L. Modified Hall technique for severely hypomineralized molars. Report of cases. Rev. CES Odont 2021; 34(1): 118-124

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

Caries is an infectious process that seriously affects dental enamel, and when it is not treated in time, it endangers the permanence of the tooth in the oral cavity.

Steel crowns are used in pediatric dentistry when primary teeth are severely damaged by dental caries. They are usually placed after pulp treatment and in hypoplastic teeth.

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The objective of the article is to provide adequate information on the Hall technique, indications, contraindications, disadvantages, and the cost-effectiveness of this procedure. A complete analysis of this rehabilitation technique for carious primary teeth.

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Altoukhi DH, El-Housseiny AA. Hall Technique for Carious Primary Molars: A Review of the Literature. Dent J (Basel). 2020 Jan 17;8(1):11. doi: 10.3390/dj8010011. PMID: 31963463; PMCID: PMC7148518.

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Hall Technique for Stainless Steel Crown in 3 easy steps

The Hall technique is an alternative to the treatment of extensive cavities that have affected a large amount of dental tissue in the primary teeth. This technique consists of placing a preformed metal crown without dental preparation.

Steel crowns are press-fitted on primary molars affected by extensive caries or when the enamel is defective. Thanks to the steel crowns, tooth loss and future occlusion problems are avoided.


We share a video that shows us how to place a steel crown on a primary molar using the Hall technique in 3 easy steps.

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Tooth Preparation for Stainless Steel Crown - Step by step

Steel crowns in pediatric dentistry are used to restore a tooth that has lost a lot of structure due to decay or trauma. Returns the chewing and occlusion functions necessary for the patient's oral health

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It is economical and quick to prepare and install, that is why it is used to this day, perhaps its only disadvantage is aesthetics.

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Crowns in Pediatric Dentistry: A Review

Maintenance of the primary dentition in a nonpathologicand healthy condition is importantfor the overall well being of the child. Treatment of the severely destructed teeth poses a challenge for the pediatric dentist as three important considerations have to be kept in mind, patient’s behavioral management, preservation of the tooth structure and parental satisfaction.

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The technological advances in dental materials for use on children that have occurred in the past few decades make constant re-evaluation of our treatment philosophies and techniques a necessitybecause what was an acceptable treatment approach in the past may not necessarily be the best treatment option for our young patients today.

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Effort has been made to bring together the various approaches for full coverage restorations in pediatric dental practice. Each technique and material carries its own advantages and disadvantages.

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Many options exist to repair carious teeth in pediatric patientsas is discussed, from stainless steel crowns to its various modifications to other esthetic crowns like strip crowns and zirconium crowns which are rising in their popularity.



° Garg V, Panda A, Shah J, Panchal P. Crowns in pediatric dentistry: A review. J Adv Med Dent Scie Res 2016;4(2):41-46.
Image: By Trikkelle - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=48700155

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Preformed crowns for decayed primary molar teeth (Review)

Dental caries (tooth decay) affects around 60% to 90% of children globally (WHO Report 2003). It most commonly occurs in primary (baby) molar (back) teeth. If left unmanaged, dental caries will progress to give pain and infection, the consequences of which are unnecessary suffering, and lost days at school (Gift 1992).

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There is evidence of a linear relationship between higher levels of caries and anthropometric outcomes (height, weight and body mass index (BMI)) (Alkarimi 2014).

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Untreated dental caries has an adverse effect on children’s ability to grow and thrive (Sheiham 2006), and in underweight children, extraction of severely carious primary teeth can improve weight gain (Monse 2012).

Teeth undergo a constant process of demineralisation (caused by the acids and enzymes produced by cariogenic bacteria in the dental biofilm (plaque)) and remineralisation (from protective factors such as fluoride and salivary components).

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Dental caries occurs when the rate of demineralisation is greater than that of remineralisation. When dissolution of enamel and dentine leads to cavitation (a hole in the tooth), the carious lesion can no longer be cleaned and it becomes more difficult to arrest the caries process as the biofilm becomes more sheltered, which favours the cariogenic bacteria (Fejerskov 2015).



° odontologiapediatrica.com
° Cochrane Library / Cochrane Database of Systematic Reviews
° Innes NPT, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM

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Preparation of stainless steel crown for the rehabilitation of primary molars

Steel crowns are the best method of rehabilitation for primary molar teeth, when they have suffered a fracture, extensive caries or some formation pathology.


The aesthetics are not liked by the patient, but it continues to be the material of first choice, due to the benefits it presents. The video that we share below shows us the steps to follow to make and adapt the steel crowns in pediatric dentistry.

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Source: Youtube/ UT Health San Antonio School of Dentistry
Image : Chompers Pediatric Dentistry