Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 | 156

ABSTRACTEsthetics by defi nition is the science of beauty that particular detail of an animate or inanimate object that makes it appealing to the eye. In the modern, civilized, and cosmetically conscious world, well-contoured and well-aligned white teeth set the standard for beauty. Such teeth are not only considered attractive but are also indicative of nutritional health, self esteem, hygienic pride, and economic status. Numerous treatment approaches have been proposed to address the esthetics and retention of restorations in primary teeth. Even though researchers have claimed that certain restorations are better than the others, particularly owing to the issues mentioned above, the search for the ideal esthetic restoration for the primary teeth continues. This paper revisits and attempts to reintroduce the full coverage restoration, namely, polycarbonate crown, for use in primary anterior teeth.

KEYWORDS: Caries, esthetic crowns, polycarbonate crowns, restorations, temporary crowns

Polycarbonate crowns for primary teeth revisited: Restorative options, technique and case reports

Karthik Venkataraghavan, John Chan1, Sandhya Karthik2

Department of Pedodontics and Preventive Dentistry, College of Dental Sciences and Research Centre, Ahmedabad, Gujrat, India, 1Kudos Crowns Limited, Hong Kong, 2Vibha Dental Care Centre, Bangalore, Karnataka, India

IntroductionEsthetics by defi nition is the science of beauty that particular detail of an animate or inanimate object that makes it appealing to the eye.

In the modern, civilized, and cosmetically conscious world, well-contoured and well-aligned white teeth set the standard for beauty. Such teeth are not only considered attractive but are also indicative of nutritional health, self esteem, hygienic pride, and economic status.[1]

There is a rapid increase in the awareness among parents of children for solutions to problems related to nursing bottle caries, malformed and discolored teeth, hypoplastic defects, tooth fractures, and bruxism.

The main problem facing the clinician while

performing esthetic restorations in children is the small size of teeth, proximity of the pulp to the tooth surface, relatively thin enamel and surface area for bonding a restoration, and the behavior of the child. The major fallout of these problems is the development of abnormal oral habits, psychological problems, reduced masticatory effi ciency, and loss of vertical dimension of occlusion.

Owing to these problems, it becomes all the more important to restore the destroyed crowns to preserve the integrity of the primary dentition until its exfoliation and eruption of permanent teeth.

Numerous treatment approaches have been proposed to address the esthetics and retention of restorations in primary teeth.[2] Over the years, there have been four types of full coverage restorations available to restore primary incisors: Stainless steel crowns[3] Open-faced stainless steel crowns[4] Polycarbonate crowns[5] Strip crowns[6]

The major stumbling block for these treatment options is the cost of the restoration. Although all of them

Address for Correspondence:Dr. Karthik Venkataraghavan, M.D.S, Professor and Head, Department of Pedodontics and Preventive Dentistry, College of Dental Sciences and Research Centre, Opposite Pleasure Club, Bopal-Ghuma Road, Manipur,Tal: Sanand, Ahmedabad 382115, Gujrat.E-mail: veekart@yahoo.co.in

Case Report

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DOI: 10.4103/0970-4388.130981

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |157

have their advantages, the limitations cannot be overlooked. These limitations described so far include the following: Metallic appearance[3] Increased chair time using multiple materials[4] Poor retention Excessive wear Technique sensitiveness Importantly, the cost

Several studies have been carried out to determine the strengths and weakness of the available treatment options, but unfortunately so far there has been a mixed response.

Even though researchers have claimed that certain restorations are better than the others, particularly owing to the issues mentioned above, the search for the ideal esthetic restoration for the primary teeth continues. One of the options available apart from the routine tooth-colored restorations is the polycarbonate crown. This paper discusses the various applications of these crowns.

Primary tooth polycarbonate crownsThis paper revisits and in a way attempts to reintroduce one of the four full coverage restoration, namely, polycarbonate crown, for use in primary anterior teeth.

Although these crowns have been available to clinicians for a few years now, owing to the initial published reports pertaining to its retention capabilities, it never got its due recognition. KudosTMTemporary Pediatric Crowns, is a crown that is easy to use and handle along with considerably reducing the chair side working time thereby overcoming the diffi culties reported so far pertaining to placement and retention. They are available as both individual as well as full arch crown and bridge both for the maxillary and mandibular anterior and posterior teeth, respectively.

This is a newer generation of Pediatric polycarbonate crowns, which is more clinician friendly and esthetically acceptable. The material is fl exible, easily adaptable, and reduces the chair side placement time considerably.

Advantages Esthetically acceptable Less chair side time Improved retention Flexible Better adaptability

Disadvantages Breakages Dislodgement Discoloration

Placement techniqueA through assessment of the case has to be carried out with regards to availability of crown structure, over jet, overbite, habits, infections, and so forth.

Once the assessment is completed, appropriate crown selection is done with care taken to determine the overall fi t of the crown over the tooth.

The tooth to be restored is then prepared fi rst mesiodistally followed by incisal reduction, leaving a featheredge margin. Care should be taken to prepare the tooth minimally.

A trial fi t is carried out to check for proper fi t, marginal adaptability, overall coverage, occlusal interference, and mesiodistal width.

Necessary adjustments are made to the polycarbonate crown, using either a crown cutting scissors or a trimming stone. Care must be taken to seat the crowns on to the prepared margins.

After the fi nal fi t is done, the crown is relined using a self-cure acrylic resin. The advantage of this type of relining technique is that the resin chemically bonds to the polycarbonate crowns. By priming the inside of the relined crown, it can be bonded to the tooth using composite resin or glass ionomer cement.

After the complete set of the reline material, the margins are trimmed and fi nished and the crown is cemented using a luting cement or composite resin.

The fi rmness of the crown allows it to serve as a provisional crown restoration up to several months/years to protect the patients teeth from trauma.

Case Reports

Case 1A male patient (aged 4 years) reported with a complaint of discolored restoration in the upper front teeth. Clinical examination revealed the presence of discolored composite restoration in 51 and 61. The parent gave a history of trauma and subsequent pulp therapy in 51. Owing to the unesthetic nature of the restoration, the parents wanted a crown restoration to be done on the affected teeth. The patient was carefully assessed according the parameters required for restoration using the polycarbonate crown. Once the parameters were found to be satisfactory, it was decided to restore the discolored teeth. Complete removal of the old restorative material and secondary decay below the restoration was carried out followed by restoration with polycarbonate crowns [Figures 1 and 2]. The patient has been under periodic clinical evaluation every 6 months for the last 18 months and the crowns have been found to be intact.

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 | 158

Case 2A female patient (aged 2 years 11 months) reported with the chief complaint of discolored front teeth. Clinical examination revealed the presence of carious 51 and 61. After careful assessment of the condition, appropriate crown selection was done followed by complete caries removal. The selected crown was then cemented after performing the necessary procedures required for its placement [Figures 3 and 4]. The patient has been under periodic clinical evaluation every 6 months for the last 24 months.

Case 3A male patient (aged 3 years 10 months) reported with a chief complaint of decayed front teeth. The main complaint of the parent was the aversion of the child toward dental treatment. The child was unwilling to have his dental examination. As the child was uncooperative, the treatment was carried out under general anesthesia after obtaining all medical clearances and signed informed consent from the parents. Complete caries excavation was performed on 51, 51, 61, and 62 followed by preparation of the teeth, and polycarbonate crown and bridge was cemented in place [Figures 5 and 6]. The postoperative healing was uneventful and the patient is under periodic clinical evaluation since past 2 years.

Case 4A male patient (aged 4 years 2 months) with a history of restorations to the maxillary central and lateral incisors reported with a complaint of fractured restorations. Clinical examination revealed the presence of dental caries in 54, 64, 74, and 84 apart from restored maxillary anterior teeth. After careful caries excavation of the posterior teeth, they were restored with stainless steel crowns. The major concern of the parents was the longevity of the anterior restorations. As the patient was found to be cooperative after careful clinical evaluation and preparation of the anterior teeth, the teeth were restored with polycarbonate crown and bridge [Figures 7 and 8]. The patient is under a routine follow up protocol since the past 30 months.

All the aforementioned cases have been recalled for periodic check ups to evaluate the crown restorations. During the visits so far, the crowns were evaluated for any kind of breakage or dislodgments. All the restorations in the respective cases were found to be retaining well with an average survival of 24 months.

Going by the presentation of the varied clinical cases it can be concluded that polycarbonate crowns for

Figure 1: Case 1Before Figure 2: Case 1After

Figure 3: Case 2Before Figure 4: Case 2After

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |159

Figure 7: Case 4Before Figure 8: Case 4After

primary teeth after proper case selection is a good treatment option available to the dentist, which will help in restoring esthetics and improve the self-esteem of the patients and at the same time protecting the tooth.

Improved modifi ability and adaptability of Kudos crowns will make them easy to place with less chair side time and better patient acceptance.

Compared with conventional restorations, these crowns provide an overall protection to the affected tooth and at the same time help in restoring the damaged tooth.

Patient and parent acceptance is greatly increased.

Finally, the cost of treatment is considerably reduced.

The main aim of this paper is to offer the clinician and in particular pediatric dentists with an alternative treatment option in their pursuit of restoring the beautiful smiles of children they see in their practices everyday.

References1. Arens D. The role of bleaching in esthetics. Dent Clin

North Am 1989;33:319-36.2. Weinberger SJ. Treatment modalities for primary incisors.

J Can Dent Assoc 1989;55:807-12.3. Hartmann CR. The open-face stainless steel crown: An esthetic

technique. ASDC J Dent Child 1983;50:31-3.4. Helpin ML. The open face steel crown restoration in

children. ASDC J Dent Child 1983;50:34-8.5. Webber DL, Epstein NB, Wong JW, Tsamtsouris A. A Method

of restoring primary anterior teeth with the aid of celluloid crown form and composite resins. Pediatric Dent 1979;1:244-6.

6. Pollard MA, Curzon JA, Fenlon WL. Restoration of decayed primary incisors using strip crowns. Dent Update 1991;18:150-2.

Figure 5: Case 3Before Figure 6: Case 3After

How to cite this article: Venkataraghavan K, Chan J, Karthik S. Polycarbonate crowns for primary teeth revisited: Restorative options, technique and case reports. J Indian Soc Pedod Prev Dent 2014;32:156-9.Source of Support: Nil, Conflict of Interest: None declared.

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