Crowns and Pulpotomy for Primary Molars
The most common reasons to use a stainless steel crown to restore a molar include extensive decay, malformed enamel or after a pulpotomy. A stainless steel crown may be used to restore a young permanent molar (before 18-20 years of age) if the enamel is severely hypoplastic (malformed). They provide a much more durable and reliable restoration for primary molars. If a child requires sedation to be treated, a stainless steel crown may be used instead of a tooth-colored filling because the crown will last until the primary molar exfoliates (falls out) whereas tooth-colored fillings may not. The crown will remain on the tooth until the tooth is lost.
Most stainless steel crowns are silver but stainless steel crowns with tooth-colored facings are available. The facings are made of an acrylic baked on to the traditional stainless steel crown. The cosmetic crowns may be more pleasing to the eye, but they do have some limitations. They may appear bulky, the acrylic facing may fracture off, the fit is not as snug and the color match may be poor. Greater tooth reduction is necessary, so the procedure may be longer in duration. If the child is not cooperative, the additional time required to fit an cosmetic crown may not be feasible. Because the cosmetic crowns cannot be crimped for a better fit, their use may not be possible for some primary molars.
No more than one appointment is necessary to restore a primary molar with a stainless steel crown. A local anesthetic is used for comfort and a rubber dam is used. The decay is removed and the tooth is reduced for the crown. An appropriate size crown is selected and cemented in place.
The crown should be brushed as usual with the other teeth. Sticky foods such as caramels and taffy can pull the crown off. If this should occur, it is not an emergency. The same crown or a new one can be placed soon afterward during normal office hours.
Pulpotomy for Primary Molars
If decay has traveled into the pulp chamber, deep inside the tooth, a pulpotomy must be performed in order to avoid an abscess. There is usually a history of the child’s complaining of some discomfort. A radiograph will confirm the depth of the decay. Local anesthesia is necessary for the child’s comfort and a rubber dam is used. A medicated filling is placed after removal of the infected tissues inside the molar’s crown. A stainless steel crown is used to proved support for the weakened walls and to protect the remaining tooth structure.
The tooth is healthy once again and should last until the Tooth Fairy says, “It’s time to go!”