Editorial: The Stainless Steel Crown Revisited

by Keith Titley, BDS, Dip Paedo, MSD, FRCD(C) and Alison Sigal, B.H. Kin, DDS, MSc (Ped Dent), FRCD(C)

Sixteen years ago, Titley and Farkouh (2001) published a paper in this journal entitled “The Stainless Steel Crown – An Underused Restoration in Paediatric Dentistry.” A review of the current literature indicates that stainless steel crowns (SSC’s) continue to be the restoration of choice by paediatric dentists for heavily decayed primary molar teeth. On the other hand large amalgam and resin materials appear to be the restorative materials of choice for general practitioners (McKnight-Hanes et al., 1991; Threlfall et al., 2005).

Very little has been written about the use of SSC’s in the permanent posterior dentition. There is no question that SSC’s have less than desirable esthetic qualities when compared with those possessed by modern ceramic materials. A recent retrospective study, however, indicated that they have proved to be effective and durable restorations in permanent posterior teeth (Sigal 2016).

Sigal’s (2016) retrospective cohort study assessed the long-term clinical and radiographic outcomes of the SSC as a posterior permanent tooth restoration. The study included 271 patients with at least one SSC restoration registered at Toronto’s Mount Sinai Hospital’s Dental Clinic for Persons with Special Needs. Two thousand, six hundred and twenty-one restorations were evaluated that included 766 SSC’s, 1651 amalgams and 204 resins. There were 883 failed restorations, 11.9% (91) SSCs, 40.7% (672) amalgams and 58.8% (120) resins. Majority of SSC failures (61.5%, 56/91) resulted in extraction secondary to generalized chronic periodontal disease unrelated to type of restoration. Whereas, caries was the primary diagnoses recorded for both amalgam and resin failures, with majority (60%) of these failed restorations successfully restored with a SSC. The survival rate over a 10-year period for 650 newly placed SSC’s and 1011 amalgams was respectively 79.2% and 63.5%. The level of oral hygiene in this special needs group was generally assessed as poor but despite this from 127 bitewing radiographs assessed, the mean alveolar bone loss from mesial and distal sites was 1.36 mm and 1.40 mm respectively (healthy). As a result it was concluded that SSC’s represent an effective, durable and recommended treatment option for the restoration of the permanent dentition.

Despite their poor esthetic properties we believe that SSC’s are also useful on a semi-permanent basis. Most practitioners who work with children have been confronted with the child who presents with one or more hypoplastic first permanent molar in what is otherwise a healthy dentition. The full surface coverage with a SSC renders the tooth resistant to caries through the development of the dentition until the appropriate time it can be replaced with an aesthetic permanent replacement. Similarly for patients with caries comprised dentitions who are candidates for comprehensive full coronal restorations and have limited financial means semi-permanent coronal coverage with SSC’s represents a viable treatment option. The evidence supplied by Sigal’s (2016) retrospective study shows that the periodontium and supporting bone are at minimal risk from SSC restorations that have been in situ for an extended period of time.

There is no question that SSC’s are viable, affordable and, more importantly, durable restorations for both primary and permanent teeth. OH

1. McKnight-Hanes, C., Myers, D., Dushku, J., & Barenie, J. (1991). A comparison of general dentists’ and pediatric dentists’ treatment recommendations for primary teeth. Pediatr Dent, 13(6), 344-348.
2. Threlfall, A., Pilkington, L., Milsom, K., Blinkhorn, A., & Tickle, M. (2005). General dental practitioners’ views on the use of stainless steel crowns to restore primary molars. Br Dent J, 199(7), 453-455; discussion 441.
3. Titley, K., Farkouh, D. (2001) Paediatrics: The stainless steel crown – an underused restoration in paediatric dentistry. Oral Health Journal, 91 (7) 50-53.
4. Sigal, A. (2016). Retrospective study of stainless steel crowns as a posterior permanent tooth restoration. M.Sc. thesis, Paediatric Dentistry, University of Toronto.

About the Editors
Keith Titley, BDS, Dip Paedo, MSD, FRCD(C), Professor Emeritus, University of Toronto.

Alison Sigal, B.H. Kin, DDS, MSc (Ped Dent), FRCD(C), is a pediatric dentist working in private practice and doing locums in northern ontario. She is a graduate from the University of Toronto Faculty of Dentistry, and is the President and Founder of the federal not-for-profit Oral Health, Total Health (www.ohth.ca) – educating, advocating, and striving towards universal access to oral health care for persons with special needs.