Definitive treatment for baby bottle syndrome and early childhood caries, part I - Strip crown success
Part I of a two-part article on BBS/ECC treatment.
When Economics and Esthetics are Essential in restoring the primary anterior dentition, for my money…and the long-term success of the restoration…and the satisfaction of my patients…and their parents…nothing beats Composite Strip Crowns. They are inexpensive, repairable, and…for the money…the best-looking anterior restorative.
The way most of us were taught to do them create some problems. They are:
- They are difficult to seat
- They pop off or chip too easily
- They can be unkind to the gingiva
Here’s how to solve these problems:
1. Carefully cut and adapt the crown form to the tooth so that the margins are as close and snug to the gingival crevice as possible. That way, after seating, you can carefully wipe away not yet polymerized composite from the margin and reduce or eliminate finishing the composite margin, once set.
2. Place 2 small holes at the incisal corners of the strip crown with an explorer so as to “vent” the composite in the crown form. This will help to fully seat the crown.
3. Place a SMALL amount of conventional composite inside the crown form (fill about ¼ of the crown form) and tamp it down onto the inside walls of the crown form so as to make a hard (when polymerized) shell of conventional composite. This will be the hard shell of your composite crown. This will also create a WELL inside the crown form/composite shell.
4. Slightly underfill the well inside the crown form/composite shell with FLOWABLE composite. This will act as a “lubricant” to FULLY seat your crown form, AND a “shock absorber” for your composite crown. Way fewer pop-offs and chips to repair!
5. Carefully wipe away excess composite that will flow out gingivally, polymerize, remove the crown form (I polish off the incisal portion, then tease off the rest with a spoon excavator), and contour and polish (which you won’t need to do much of).
Editor's note: For part II of this article, click here.
Dr. Howard Elson is a pediatric dentist practicing in McKeesport, PA. For full bio, see below.
This article is a part of the Dental Economics "Spotlight on Pediatric Dentistry," with exclusive content posted on the Dental Economics Facebook Page and archived at http://www.dentaleconomics.com/pediatric-dentistry-spotlight.html. The spotlight runs February 1st - 28th, 2014, in recognition of National Children's Dental Health Month, and is sponsored by Dentsply Professional and Nupro White Varnish.
Dr. Howard Elson is a graduate of Queens College in New York City and the New Jersey Dental School (which became the University of Medicine and Dentistry of New Jersey, which became Rutgers). After serving in the U.S. Army at Fort Jackson, SC, where he “preserved the biting strength of our combat troops,” Dr. Elson completed his residency at Allegheny General Hospital in Pittsburgh. After he graduated, they closed the program and bought helicopters with the money they saved.
Dr. Elson has presented many seminars and lectures on pediatric dentistry, and has served as local dental society president and public relations director for the Dental Society of Western Pennsylvania. He has served as Associate Clinical Professor at the University of Pittsburgh School of Dental Medicine and started the pediatric dental program at Southwestern Ambulatory Surgical Center, where he maintains a staff appointment. A Fellow of the International College of Dentists, Howard has received awards and commendations from the United States Army, Alpha Omega Dental Fraternity and the American Society of Dentistry for Children, among others. He is currently a consultant with Avesis Dental and a member of the ADA Medicaid Provider Advisory Committee. At the 2013 ADA Convention in New Orleans he presented, “Why I Am a Medicaid Provider.”
Howard is also a professional actor and singer, having starred in productions of “Fiddler On The Roof,” “Chicago,” “A Little Night Music,” and “A Funny Thing Happened On The Way To The Forum,” among others. He has had his own sports talk show and in 1988 was honored as “Western Pennsylvania’s funniest and best commentator” for his sports/humor radio commentaries. He also travels the country performing his one man show for dental conventions, “Dr. Howard Elson, A Dentist’s Life!” His CD of special material songs and comedy, all about the practice of dentistry, can be purchased on his website, www.thedentalshow.com.
Howard and wife Robin, a CPA, have two children; Philip, the play by play voice of the Arkansas Travelers, the AA affiliate of the Los Angeles Angels of Anaheim, married to Julie, and Lauren, the Family Life Director at the Jewish Community Center of Pittsburgh, and four beautiful (are there any other kind?) grandchildren; Sadie, Gabriel, Dylan and Lily.