Stainless Steel Crowns - A Complete and Definitive Guide

Dental crowns are prosthetics which are used to cover up misshapen teeth and restore the smile on your face. We’ve seen a number of villains smile wide with stainless steel crowns. If your teeth are weak or broken, these crowns are an excellent fix. They are also used to provide support in case you are getting a dental bridge.

The most popular dental crowns are stainless steel crowns. There are different dental crowns that you can make use of, but you must be well informed before you pick one. So, we are here to tell you all about stainless steel crowns and why you should or should not choose them.

Stainless steel crowns are extra-coronal restorations that are used particularly in the restoration of grossly broken down teeth and large multi-surface cavities. The placement of traditional stainless steel crowns can be challenging for the patient as well as the clinician since it is associated with tooth preparation.

Stainless steel crowns, also referred to as preformed metal crowns were introduced by Humphrey to pediatric dentistry in 1950. They are used as an alternative to silver and tooth-colored fillings. Most of them last four years or more and they also have a polished surface that makes it easy to cleanse. They are also known as silver crowns and are employed in the case of badly broken primary teeth or milk teeth. They are durable, corrosion-resistant, inexpensive, and help in safeguarding the decayed teeth of children.

Stainless steel crowns are used to repair a decayed molar by professional dentists. It also prevents the teeth from further decaying. They are made in the exact size of a child’s molar. They are subjected to negligible sensitivity during replacement and offer the advantage of full coronal coverage. It is possible to place a well-fitting crown without compromising the quality or longevity of a crying child. Therefore, stainless steel crowns are used in restoration due to an inability to control the secretion of saliva.

SOME FACTS ABOUT STAINLESS STEEL CROWNS

Contains only safe metals
Does not impair the growth of permanent teeth
Are easy and simple to apply
Will fall out naturally when the child’s teeth fall out
Offers an alternative in removing a decayed tooth
Stainless steel dental crowns are used by dentists and orthodontists throughout the globe.
Stainless steel crowns are used mostly as a temporary fix while some other crown made from another material is being processed.
These dental crowns are made only out of metals that are safe and will not cause irritation.
Stainless steel crowns are used on children in order to fit a primary tooth that has been made to fit it.
You can get a stainless steel crown installed in a single visit to the dentist.
Stainless steel dental crowns are less expensive than other dental crowns.

STAINLESS STEEL CROWNS FOR ADULTS

Stainless steel dental crowns are preformed metal crowns that can be used on teeth. They are used primarily on milk teeth, mostly in the back. They are not preferred on front milk teeth because they are distinct and not very flattering.

What most people do not know is that stainless steel crowns are also used on permanent molars in adults.

STAINLESS STEEL CROWNS FOR CHILDREN

Since they were invented in the 1950s, these stainless steel crowns have been very effective on milk teeth. As they are preformed, they sit well on teeth and perform all the basic functions that the crown of a tooth would.

It is also extremely convenient that the stainless steel crown will fall off easily when the milk tooth does, without causing any complications. Furthermore, this dental crown is built to last long until the tooth actually falls out. You need not pay many visits to the dentist until then.

Stainless Steel Crowns (or SSCs) are preformed metal crowns that help in protecting baby (primary) teeth. As the name implies, they are metal crowns, which are made of stainless steel and contain chrome & nickel.

If your child is physically or mentally disabled and cannot be subjected to intensive oral care and maintenance, stainless steel crowns are the best option for them. These dental crowns can also be used to repair damaged and broken teeth.

When a tooth is severely damaged due to dental caries or needs to undergo pulp treatment, a stainless steel crown is the best option. Any abnormal birth defects on your teeth can also be combated with the use of a stainless steel dental crown.

Please keep in mind to consult your dentist before picking out the dental crown that will work for you. If you are allergic to metal, this dental crown is not for you.

These prefabricated crowns are adapted to the damaged teeth and cemented with biocompatible luting agents. They are popular in fixing a lost tooth, helping to improve the overall structure of the young teeth.

They were introduced by Dr William Humphrey & Engel in 1950 as chrome-steel. Later, in the 1960s, they were significantly improved by Unitek. Since then, a lot of studies have been conducted and as a result, SSCs have been proven superior when compared to an amalgam restoration, especially for multi-surface cavities in primary molars.

Benefits of Using Stainless Steel Crowns

Dentists offer different types of dental crowns like the ones made from zirconium oxide & resin. Though these options are readily available, the classic remains as such. When you compare stainless steel crowns with other restorative materials, their success rate is about 96%. Besides this, the benefits of stainless steel crowns are diverse, which include:

Affordability: When compared to others, stainless steel crowns are less expensive and tend to have more perks than them.
Durability: According to research, steel caps are highly helpful in keeping even the badly damaged teeth in shape. It is one of the best alternatives to any other non-durable, aesthetic option such as ceramic, porcelain or white zirconia dental crowns. Stainless Steel Crowns are perfect for posterior teeth.
Adaptability: Generally, dentists do not prefer using SSCs for adults. But they could assist in conditions where a patient suffers from a health issue and all the other options are difficult. This sounds ideal during situations like pregnancy and senior citizens.
Ease of Use: Most dental crowns require attaching them to the damaged tooth without bleeding or moisture getting in the way. But SSCs do not have sensitivity to such factors. A dentist can smoothly contour and trim the steel caps for that “perfect” fit.
Increases Strength: The main goal of using a stainless steel crown is to help restore a tooth’s size & shape, enhance its strength, and make it look much better. Therefore, for patients, who really need them, they make a huge difference for their oral hygiene. They are also perfect for teeth that are involved in breaking down food, chewing and grinding, therefore taking upon a considerable amount of labour.
Complete Coverage: A stainless steel crown is a wonderful alternative to tooth-colored and silver fillings. Since it is a durable metal cap, it offers complete coverage to the damaged tooth. In most cases, where the posterior or back teeth are damaged, tooth-coloured alternatives may not be suitable as they cannot cover the entire space and shape of the teeth. This is where the Stainless Steel crown comes into picture.
Easy Maintenance: SSCs have a polished and smooth surface. This feature makes them completely easy to maintain and clean. When well-maintained, they can last for 4 years or even more. They are also quite cheaper when compared to tooth coloured alternatives and require much less upkeep. The maintenance is quite easy and it hardly ever requires a re-visit to the dentist for re-examination.

When are Stainless Steel Crowns Used?

A dentist suggests stainless steel crowns for children during any one of the following:

Restore a broken or severely damaged tooth
Protect a weak tooth
Cover a dental implant
Hold a dental bridge in place
Recurring dental caries
Rampant dental caries
Extensive decalcification
Extensive dental caries
After a pulp therapy
Severe bruxism (or tooth grinding)
Acquired or inherited enamel defects
Kids with higher rate of dental caries
Fractured or broken tooth
Abnormal tooth structure from the birth
Abnormal tooth structure due to a disease
For intermediate restoration

When are Stainless Steel Crowns Not Used?

A stainless steel crown is never suggested in any of these cases:

Individuals with nickel allergy
Teeth that cannot be restored
Mobile teeth
Molars with half of the roots or more are resorbed
Primary molars that are next to exfoliation

The potential risks of using SSCs include:

Unaesthetic or looks unpleasing
Cannot be used if the patient is allergic to nickel
Substantial amount of tooth structure is discarded
Gingival inflammation because there is unremoved excess cement

TYPES OF STAINLESS STEEL CROWNS FOR CHILDREN

Stainless steel crowns that were used earlier posed issues in technique due to poor anatomy and gingival contours. However, the crowns that are used today, have lesser problems due to their festooned gingival contours, wide range of sizes, and shallow cuspal anatomy. When it comes to pediatric dentistry, the most common options used today are as follows:

PRECONTOURED CROWNS

These crowns are pre-contoured and also festooned. Some contouring and trimming might be necessary but is usually minimum. The pre-contour is lost and the crown will fit more loosely if the trimming of the crown becomes necessary. They reduce the operating time. However, a little trimming and contouring might be necessary.

PRETRIMMED CROWNS

These crowns have non-contoured, straight sides to follow a parallel line to the gingival crest. The crowns still need contouring and trimming. These have straight sides and are festooned so that they are parallel to the gingival crest. But they still need contouring as well as trimming.

PREVENEERED CROWNS

These are the crowns that have resin-based composite to create a more aesthetic posterior crown. They are bonded to the occlusal and buccal surfaces. They are more expensive than the other stainless steel crowns, require tooth reduction, and allow for only less crimping for crown adaptation.

STAINLESS STEEL CROWNS WITH WHITE FACINGS

In order to make the steel crowns look more appealing, particularly when front teeth are concerned, there are SSCs with pre-veneered plastic facings. These look much better due to the fact they are “white.” But for the white facing to stick to the metal, additional bulk should be added. This ensures that the crown looks rounded or bulbous. Also, note that the white facing can chip off after some time, which in turn, exposes the silver crown beneath. Chipping mostly occurs when kids grind their teeth often. This exerts pressure at the back.

STAINLESS STEEL CROWNS V/S PORCELAIN CROWNS

The obvious difference between the two can be derived from their name: stainless steel crowns are made of stainless steel, while porcelain crowns are made of porcelain with an underlying metal for strength.

Stainless steel crowns are also more of a temporary fix when compared to porcelain ones. The former is also primarily used on children, while the latter is used on adults.

Porcelain Crowns come in two major forms - Full Porcelain Dental Crowns and Porcelain fused to metal crowns. Full Porcelain crowns are one of the most elegant and natural looking dental crowns that has ever been made by dentists. They have a transparent nature to them which naturally takes on the colour of the original tooth underneath it. This therefore can be the best option for anterior teeth for mostly aesthetic reasons. They are generally not recommended for back teeth as they are not as durable as other dental crowns. Another downside to porcelain crowns are the high costs and high preparation time. Given its natural teeth-like quality and appearance, it takes much longer time, expertise and money to make dental crowns made from all-porcelain.

FACTS ABOUT STAINLESS STEEL CROWNS V/S PORCELAIN CROWNS

Stainless steel crowns are used mostly as a temporary fix while some other crown made from another material is being processed.
Porcelain crowns are made to be the same colour as your teeth, and so are a good fit.
Porcelain crowns are said to be good for both front and back teeth.
Stainless steel crowns are used on children in order to fit a primary tooth that has been made to fit it.
Both stainless steel and porcelain dental crowns are used by dentists and orthodontists all over the world.

PROS AND CONS OF STAINLESS STEEL CROWNS

Pros:

The best option when a temporary fix is needed
Not very expensive
Works well on children
Protects the entire tooth from decay by covering it fully
They do not require many dental visits to be installed

Cons:

Not suitable as a permanent fix
Does not blend in with the rest of your teeth

PROS AND CONS OF PORCELAIN CROWNS

Pros:

Blends in well with the rest of your teeth
These crowns serve as a permanent fix
Works well on both front and back teeth
These crowns work well on long bridges wherein metal is needed
Best option for people with metal allergies

Cons:

Prone to chipping when in contact with other teeth for a period of time
Metal under porcelain can show through as dark line
More expensive
Takes a long time to prepare
Needs expert placement by the dentist

PORCELAIN FUSED WITH METAL CROWNS

Porcelain Fused with Metal is another Dental crown that is similar in functionality to Metal crown but has the aesthetic quality of a porcelain crown. Porcelain Fused with metal crowns have a metal base or core made from safe metal alloys. This part attached itself to the original tooth and is cemented by the dentist to your original teeth. Porcelain or ceramic top is then fused to this metal in the shape of the original tooth to form the outer structure with its shape and colour. This bonding is done by a dental glue.

Next to Stainless steel crowns, they are the second best durable crowns in the market that combine the elegance and aesthetics of porcelain which resembles the original tooth against the strength and durability of a metal core made by a metal alloy, thereby making it stronger than all-porcelain crowns.

PROS:

Teeth like-appearance in the top structure
Solid, metal core for strength
Durable and lasts as long as 2 to 3 years
Requires less upkeep than all-porcelain crown
Can be moulded to fit the original space perfectly

Cons:

An expensive option as it contains a major portion made out of porcelain
Even though the tp structure is transparent, the metal lining below does show up, therefore it needs an opaque porcelain to cover the metal appearance
This reduces the natural shine and luster of an original tooth
There is possibility of damage or fracture of the porcelain part which needs immediate attention by a dentist
When the gum recede due to age, the metal lining may show through in time
The porcelain portion does have the tendency to wear down the opposing tooth

STAINLESS STEEL CROWNS V/S WHITE CROWNS

As we have already discussed, Stainless Steel is a type of Dental crown that is designed with Stainless steel along with nickel and other safe metals to cover misshapen or damaged teeth to prevent further damage and to protect other teeth in the jaw.

White Dental Crowns are made from Zirconia, which may look similar to porcelain but is better functioning and more durable than porcelain in all respects. The best thing about White ZIrconia Dental crowns are that they are similar to the human teeth and are perfect replacements or alternatives to Stainless Steel Crowns.

White Zirconia crowns are used to replace teeth that are infected by large cavities and cannot be filled without the risk of breaking the natural tooth. It is also an alternative to broken, disfigured, non-developing or chipped teeth. With the invention of zirconia and porcelain dental crowns, there is no longer need for extraction as the dentists can go in with the replacement of such teeth with natural looking dental crowns, especially for aesthetic reasons.

Zirconia is a safe replacement for crowns especially used in pediatric dentistry. It is a complete biocompatible material that has been in cosmetic surgery for a long time now. Zirconia is used as a solid Monolithic Zirconia Ceramic which can easily blend into your child's anterior teeth and look very natural. They are extremely easy to use as they do not require any casting and come prefabricated, therefore all your dentist needs to do is to place the appropriate crown size over the tooth and cement it with an appropriate Dental cement such as Resin or Glass Ionomer.

ADVANTAGES OF WHITE CROWNS:

They are similar to tooth color
Do not cause allergies
Can be fitted in one sitting
Durable for Anterior teeth

DISADVANTAGES OF WHITE CROWNS:

The dentists find it difficult to place a white crown over a problematic tooth. These crowns take some time to fit to the tooth.
They cannot be trimmed on the edges
To remain attached to a tooth, dentists use glue for white crowns. Yet, this glue can get degraded with time.
Cannot be performed on patients with significant crowding
Cannot be performed in space loss
Cannot be used on tooth which has very little remaining
Patients with teeth grinding (Bruxism)

STAINLESS STEEL CROWNS - ADVANTAGES:

Popular in pediatric treatment of children’s temporary tooth
Used for sixty years
Composed of a mixture of several metals (iron, chromium, and other types)
The other name for SSC is shining teeth
Used for less visible teeth (molar teeth)
Known for their durability and strength
Comes at a moderate cost
Can be placed at a single visit and no need of retreatment
They can last for two to ten years

DISADVANTAGES:

Cannot be placed in children/patients who have an allergy to metals
Cannot be placed in patients suffering from gingivitis

STAINLESS STEEL CROWNS - INDICATIONS FOR USE

Restoration of young or primary teeth with extensive carious lesions. The primary molars with interproximal lesions are also included.
It is used on primary molars when an amalgam possibly fails. For example, when the proximal box goes beyond the line angles in a cavity.
It is considered to be the restoration of choice after pulp theory.
An extreme risk of recurrent caries and extensive decalcification around an already restored tooth.
Immoderate tooth wear from bruxism.
There should be strong consideration given to the children who need general anesthesia for general treatment
Developmental defects like dentinogenesis im-perfecta, amelogenesis im-perfecta, and hypocalcified teeth.
As a prop to space maintainers or prosthetic appliances.
Fittings for orthodontic appliances and habit- breaking.
Disabled children with poor oral hygiene.

CONTRAINDICATIONS

Patient ineffective to cooperative with the treatment
Patient having nickel hypersensitivity
Primary tooth approaching exfoliation. Half of the primary tooth will be shown resorbed in X-ray.
Esthetics in teeth is the main reason.

INSTALLING A STAINLESS STEEL CROWN

DIAGNOSIS AND PRELIMINARY INVESTIGATION:

Before determining if and where to place a dental crown, a dentist takes x-rays to carefully examine your teeth and what exactly would work on them. Once the x-ray confirms that a crown is needed, they move on to the next steps.

If the dental crown placement is preceded by a pulp treatment, no additional local anaesthesia is required as the one from the pulp treatment would be more than enough. However, in case only the dental crown must be installed, local anaesthesia is administered to make the process comfortable.

ANESTHESIA

Effective anesthesia is given as the preparation will extend with the inevitable trauma of gingiva. There are different conditions under which general anesthesia in pediatric dentistry is indicated:

Patients in need of significant dental treatment with medical conditions
physical and mental disabilities
Very young patients with nursing bottle caries
Patients from remote areas with extensive dental needs where access to regular dental care is not available.
Extreme anxiety, non-cooperation, and fearfulness
Allergy to local anesthetics

THE PROCEDURE

A rubber dam, which is a smooth sheet made of latex, is used to isolate the tooth that is in need of a dental crown. This prevents any debris from interfering with the procedure and also makes the tooth clearly visible to the dentist. Upon doing this, the working space remains free from moisture, debris, and further, ensures that the area is properly visible.

To obtain the clearance of 1mm, occlusal reduction is carried out. The contact points like mesial and distal are cleared, a taper from occlusal to gingival is acquired free of ledges. The line angles are surrounded off and all carriers are removed.

The preparation of stainless steel crowns does not have to be accurate because they are not close-fitting. The gingival finishing line should not have ledges, it should be a feather edge. A reasonable taper will help achieve this if a ledge is present. The operator will feel difficulty in placing the crown and there are possibilities to trim it unnecessarily but it is the ledge that should be removed. There is no preparation needed on the lingual or buccal surfaces except when there is a mesiobuccal convexity. These crowns can spring over as they are flexible enough.

At first, the biting surface is declined by 1.5mm approx. following the tooth’s contours. A wooden wedge is kept between the adjacent tooth and the tooth that is being treated to reduce damage on the adjacent tooth.

The adjacent surfaces of the teeth are trimmed slightly more than usual. In this way, the multiple crown placements will be easier. The finishing line should be 1mm beneath the gingival margin. The crown with the correct size is selected after measuring the width of mesiodistal connecting the contact points of the adjoining teeth with calipers or the mesiodistal width of identical teeth in an opposite arch will be measured if teeth are missing. It is preferable to go for a small crown to fill in the place.

FITMENT

While fitting a crown for a second primary molar in a place where the permanent molar has not yet erupted, care must be taken when measuring the mesiodistal dimension for the crown. If the stainless steel intrudes on the space needed for eruption, its eruption pathway may be distorted. The crown is placed lingually and rolled over the preparation to the buccal margin to place it on a prepared tooth. As the crown springs into place over the gingival undercut area, it will make an audible “click”. To place the crown, firm pressure is usually necessary.

The marginal gingiva is seen to flinch with a well-fitting crown as it seats. The crown margin is placed approximately 1mm subgingivally both to give confinement and a good cement seal. The crown will need to be trimmed if excess gingival blanching.

A sharp scalar or bur is used to trim the crown to 1mm below the scribe line along the gingival contour. The occlusion is examined and the crown removed with a sharp excavator. Crown scissors are used for trimming. The crown will have a larger cervical gap after trimming and must be crimped to recover its retentive contour. To crimp stainless steel crowns, crimping pliers are recommended. The crown should be thinned and smoothed slightly with a large “heatless” stone once the adjustments are completed. A rubber wheel is used for final polishing.

After selecting the right crown, the margins are altered to fit the tooth of a certain individual. The tooth and the crown must be washed well and dried to prevent infection.

CEMENTING

The crown is now ready to be cemented with glass ionomer, zinc phosphate cement, or polycarboxylate. The crowns are not a tight fit except at the margin therefore larger volume of cement should be mixed. Excess cement flowing from the margins is an indication of an inadequate volume of cement. To remove excess cement from this region, a dental flow is passed below the contact point and interproximal area.

The cement is mixed and used to fit the crown. After the end of the procedure, the patient is asked to bite down on the tooth to remove the excess cement. The rubber dam and wooden wedge are removed and the area is cleaned.

The crown is finally checked for occlusion. The patient should be informed that there may be some temporary discomfort in the gingival area when the anesthetic wears off.

AFTER CARE - POST PROCEDURAL CARE

After the numbness from the surgical procedure has worn off, you will begin to feel some discomfort. Do not worry, as this is normal. In case there is pain, you can contact your dentist and get some painkillers.

Sticky food will cause irritation to your tooth. So avoid these for a while after your dental crown has been fixed. A minimum time of one week is recommended. You must also remember to brush and floss regularly. Doing both twice a day is highly recommended and will yield the best results.

If you rinse your mouth with warm salt water two or three times a day, the discomfort can be dealt with in a natural manner. This will also help clean your mouth. If you see a white line under the crown, plaque has built up and will need brushing.

Pain is a quite common occurrence, so allow yourself a discomfort period of at least two weeks. In case there is extreme pain, irritation or bleeding, contact your dentist and fix an appointment immediately. Normally, there is no need for follow-up visits with the dentist regarding stainless steel crowns.

Aftercare of Stainless Steel Crowns For Children

After a child goes through the dental procedure and has his/her steel crown placed, here’s what aftercare requires:

After the numbness from anesthesia is gone, the child might experience some discomfort but the dentist will prescribe a few painkillers to keep things under control.
Make sure that the child doesn’t bite the lip, cheek, or tongue.
Avoid sticky foods for the next 4-5 days after the dental procedure.
To prevent the gums from being irritated, brushing & flossing should be done. Even though the area may swell or bleed, regular brushing & flossing will keep the gums healthy.
Rinse the mouth with lukewarm water 2-3 times per day to reduce soreness around the gums.
Steel crowns are glossy and should be maintained in the same way. However, if there is a white line at the bottom or the crown looks cloudy, then it is a sign that there is plaque buildup. In this case, brushing should be done promptly.
Since the crown is newly placed in the mouth, the child will experience slurred speech, mild pain while biting and chewing on the cheeks. This is common and it will take about 2 weeks for the child to adjust with it.

You also need to take good care of the dental crown. The activity includes daily brushing, removing the items caught between the teeth by flossing and eating only health-based foods. Avoid ice creams, candies for at least a month after the capping procedure.

The crown can last for a duration of five to fifteen years. You also need to schedule regular check-ups with your dentist.

COMPLICATIONS

Always discuss the potential problems that can arise after the crown installation with your dentist for your unique situation
If you are eating hard foods such as non-vegetarian dishes, then there are chances that the crown can fall or get loosened.
In case, the crown has suffered a fracture, you may need a replacement or recementing procedure. Please visit the dentist or the crown will suffer more damage. Then you may have to pay for the entire tooth cap again.

Longevity of Stainless Steel Crowns

There are many types of dental crowns, but, if the patient is a child, then stainless steel crowns are preferred. The composition is nickel, carbon, iron and other metals. They are designed in a specific way to be more durable and strong. The planting of SSC after the cleaning procedure can restore the normal function in your affected tooth. The success rate of stainless steel crowns is an alarming 88 percent when compared to its counterparts. Based on a survey conducted in 2017, these crowns have a better survival rate of 6 percent in comparison with metal fillings. Therefore in retrospect, it is ideal to use Stainless Steel in instances such as:

The teeth have to do strenuous functions such as breaking bones and grinding hard food
It is also used in places with fractured teeth
Unlike its counterparts, stainless steel crowns require just one visit to the dentist. You do not have to worry about the stress of retreatment.
This crown proves the best alternative for uncooperative children
Stainless Steel crowns last much longer and require very minimal upkeep
They are also quite economical and their maintenance is justifiable
Although they might not be aesthetic, they still are one of the most sturdy and durable option when it comes to posterior teeth replacement using dental crowns

Conclusion

It is clear from this article there arguments that are for and against each type of dental crown and their respective counterparts. We have also explored in great detail the advantages, benefits, indication of usage, contraindication, alternatives for stainless steel crowns etc. It is therefore quite safe to establish that if you are a patient with no metal allergy and with a comparatively good range of dental health within reason, a stainless steel dental crown may be one of the best options.

Due to its non-aesthetic nature, it may be recommended to use them for pediatric dentistry purposes as they can easily be replaced in time and are usually very safe in children that have no contraindications or allergies.

Stainless steel crowns are best suited for kids as they are quick, effective, require minimal upkeep and maintenance and can be replaced with suitable alternatives as and when they grow up. Also, they are quite inexpensive when compared to other dental crown alternatives. Therefore it is a safe bet for children especially for molar teeth replacements.

The post care routine and procedures must be strictly followed by parents and should be clearly executed to avoid any infection, fracture or damage of the crown. It is usually easy to maintain these if you just go by the simple dental hygiene rules and stick to the do’s and don'ts after crown placement that is handed down by your dentist.