Are crowns too radical for baby teeth?
You might be surprised to know that the consensus among paediatric dentists is that crowns are not too radical for baby teeth. Quite the contrary, crowns may be the preferred treatment option for some damaged baby teeth.
Baby teeth are important. When baby teeth are damaged, timely management is necessary. Left unmanaged, the problem is at risk of progressing and causing increasing discomfort. There are several common reasons why baby teeth may be damaged:
- Dental developmental defects e.g. teeth with poorly formed enamel and/or dentine
- Dental decay
- Tooth wear e.g. wearing down by severe grinding (attrition), thinning of enamel by acids in mouth (erosion)
- Trauma and injuries
Damaged baby teeth may be managed restoratively using fillings. Fillings are used in both front teeth and back teeth. Fillings may be tooth-coloured, fun colours e.g. pink or silver. The strength of filling materials varies. Some filling materials are fluoride releasing and some are not. The ways by which the filling material retains or sticks onto the damaged teeth also vary. For example, some filling materials stick to the damaged teeth chemically, other filling materials require the dentist or dental/oral health therapist to prepare the area to enable mechanical retention. The dental practitioner makes the choice of which filling material or a combination of materials to use, based on current research evidence and factors such as severity, location, size and shape of the damaged tooth area, patient’s age, habits, health and oral disease risks.(1-3)
Preformed crowns are also commonly used for the management of damaged baby teeth. Manufacturers make these crowns to resemble the natural shape of each tooth types and in a variety of progressive sizes. The dental practitioner prepares the tooth, selects the right-sized and -shaped preformed crown to fit the prepared tooth and cements the crown. Crowns generally provide the best longevity and overall protection of the damaged teeth. For severely damaged baby teeth and/or where teeth are damaged at a young age, crowns are preferable over fillings.
Preformed stainless steel crowns are often used for damaged primary molars and first permanent molars.(4) Stainless steel crowns are durable, silver in colour and have withstand the test of time in dentistry.(5,6) As dental practitioners, we may refer to crowns as “jewels” or “superhero teeth” to our children patients.
Pre-veneered stainless steel crowns are also available for a more tooth-coloured appearance. These crowns are available for front teeth as well as back teeth. However, the tooth-coloured facings or veneers are prone to breaking off from the stainless steel crowns over time.(7,8) A study published by O’Connell et al. (2014) reported almost 50% of facings fractured from pre-veneered stainless steel crowns within 3yrs.(8)
More recently, preformed zirconia crowns have become popular. Zirconia crowns are tooth-coloured and very aesthetic. Zirconia crowns are available for front teeth and back teeth. It is worth noting that, zirconia crowns require more aggressive tooth preparation, is more technique sensitive and more expensive.(9) There is also concerns that zirconia crowns may fracture more easily under chewing and clenching forces than stainless steel crowns.(10) Longitudinal research supporting the use of zirconia crowns over stainless steel crowns is also not yet available.
There is increasing support in different parts of the world for the Hall’s Technique.(11-13) This is a procedure involving the use of preformed stainless steel crowns over decayed baby molars, without cleaning out the decay first. The rationale supporting this procedure rests upon current knowledge that bacterial activities are essential to the tooth decay process and that by sealing and containing the bacteria in tooth decay under a crown, these bacteria will die and therefore unable to carry out bacterial activities that lead to further decay. The decay process becomes arrested under the sealed crown and an environment for natural tooth repair enabled. Available results from recent clinical trials of the Hall’s Technique is supportive of the procedure as an alternative treatment option for decayed baby teeth, especially when conventional restorative treatment is not possible due to patient’s age or limited cooperation.(14-16) However, there are also studies that do not support the use of the Hall Technique compared to conventional crown placement in primary molars.(17,18)
To make informed decisions for our children’s oral health (an integral part of overall health), don’t be afraid to ask your dental team for details and explanations regarding the treatment options available. There are more treatment options available these days than ever before. Even “just a filling” can be performed in a variety of ways.(19) Sometimes, remineralization via minimally invasive interventions and stringent oral hygiene will suffice.(20) Other times, crowns may be the best option. Being radical can be a good thing, especially if it can save a child from anxiety and discomfort that accompany ongoing treatment needs and retreatments over time.
- Tran LA, Messer LB. Clinicians’ choices of restorative materials for children. Aust Dent J 2003; 48(4): 221-232.
- Yengopal V, Harneker SY, Patel N, Siegfried N. Dental fillings for the treatment of caries in the primary dentition. Cochrane Database Syst Rev 2009 April 15(2): CD004483. doi: 10.1002/14651858.CD004483.pub2.
- Hutcheson C, Seale NS, McWhorter A, Kerins C, Wright J. Multi-surface composite vs. stainless steel crown restorations after mineral trioxide aggregate pulpotomy: a randomized controlled trial. Pediatr Dent 2012;34(7): 460-467.
- Rogers HJ, Batley HA, Deery C. An overview of preformed metal crowns. Part 1: Conventional technique. Dental Update 2015; 42(10):933-6,938.
- Seale NS, Randall R. The use of stainless steel crowns: a systematic literature review. Pediatr Dent 2015; 37(2): 145-160.
- Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. Preformed crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2015; 31(12):CD005512. doi: 10.1002/14651858.CD005512.pub3.
- Kratunova E, O’Connell AC. A randomized clinical trial investigating the performance of two commercially available posterior pediatric preveneered stainless steel crowns: a continuation study. Pediatr Dent 2014; 36(7): 494-498.
- O’Connell AC, Kratunova E, Leith R. Posterior preveneered stainless steel crowns: clinical performance after three years. Pediatr Dent 2014; 36(3): 254-258.
- Clark L, Wells MH, Harris EF, Lou J. Comparison of amount of primary tooth reduction required for anterior and posterior zirconia and stainless steel crowns. Pediatr Dent 2016; 38(1): 42-46.
- Townsend JA, Knoell P, Yu Q, Zhang JF, Wang Y, Zhu H, Beattie S, Xu X. In vitro fracture resistance of three commercially available zirconia crowns for primary molars. Pediatr Dent 2014; 36(5): 125-129.
- Hyde AC, Rogers HJ, Batley HA, Morgan AG, Deery C. An overview of preformed metal crowns. Part 2: The Hall Technique. Dental Update 2015; 42(1): 939-942,944.
- Welbury RR. The Hall Technique 10 years on: its effect and influence. Br Dent J 2017; 222(6): 421-422. doi: 10.1038/sj.bdj.2017.262.
- Innnes NP, Evans DJ, Bonifacio CC, Geneser M, Hesse D, Heimer M, Kanellis M, Machiulskiene V, Narbutaité J, Olegário IC, Owais A, Araujo MP, Raggio DP, Splieth C, van Amerongen E, Weber-Gasparoni K, Santamaria RM. The Hall Technique 10 years on: Questions and answers. Br Dent J 2017; 222(6): 478-483. doi: 10.1038/sj.bdj.2017.273.
- Innes NP, Evans DJ, Stirrups DR. Sealing caries in primary molars: randomized control trial, 5- year results. J Dent Res 2011; 90(12): 1405-1410.doi: 10.1177/0022034511422064.
- Innes N, Stewart M, Souster G, Evans D. The Hall Technique: retrospective case-note follow-up of 5-year RCT. Br Dent J 2015; 219(8): 395-400. doi: 10.1038/sj.bdj.2015.816.
- Ludwig KH, Fontana M, Vinson LA, Platt JA, Dean JA. The success of stainless steel crowns placed with the Hall technique: a retrospective study. J Am Dent Assoc 2014; 145(12): 1248-1253. doi: 10.14219/jada.2014.89.
- Nainar SM. Success of Hall technique crowns questioned. Pediatr Dent 2012; 34(2): 103.
- Erdemci ZY, Cehreli SB, Tirali RE. Hall versus conventional stainless steel crown techniques: in vitro investigation of marginal fit and microleakage using three different luting agents. Pediatr Dent 2014; 36(4): 286-290.
- Schwendicke F, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, van Landuyt K, Banerjee A, Campus G, Domejean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NP. Managing carious lesions: Concensus recommendation on carious tissue removal. Adv Dent Re 2016; 28(2): 58-67. doi:10.1177/0022034516639271.
- Innes NPT, Schwendicke F. Restorative thresholds for carious lesions: systematic review and meta-analysis. J Dent Res 2017; 96(5): 501-508. doi: 10.1177/0022034517693605.