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1113-5181/10/18.3/185
ODONTOLOGA PEDITRICA ODONTOL PEDITR (Madrid)
Copyright 2010 SEOP Y ARN EDICIONES, S. L. Vol. 18. N. 3, pp. 185-200, 2010
Revisin
RESUMEN ABSTRACT
Entre los materiales restauradores disponibles ms usados Composites, dental amalgam and preformed metal crowns
en odontopediatra encontramos: los composites, la amalgama are the most widely used restorative materials in paediatric
y las coronas metlicas preformadas. El composite es el mate- dentistry. Composite is the material of choice for restoring
rial de eleccin cuando se trata de restaurar cavidades tipo I, II type I, II and V cavities in the two dentitions. However, the
y V en ambas denticiones. Sin embargo, cuando se ven invo- preformed metal crown is the best option when there are 3 or
lucradas 3 o ms superficies, la mejor opcin son las coronas more surfaces involved.
metlicas preformadas. At present, two groups of crowns are used in paediatric
Actualmente, existen dos grandes grupos de coronas en dentistry: metal crowns and aesthetic crowns. Within these
odontopediatra: las coronas metlicas y las estticas. Dentro two groups, there are a number of types with different proper-
de cada grupo, podemos encontrar diferentes tipos en funcin ties, depending on the location in the dental arch to be
de la situacin en la arcada del diente a restaurar, o de las pro- restored.
piedades que necesitemos. This review aims to analyze the evolution of crowns as a
El objetivo de esta revisin bibliogrfica es analizar la evo- restorative material in primary teeth and their properties,
lucin de las coronas como material de restauracin en denti- advantages and drawbacks.
cin temporal, as como sus propiedades, ventajas y desventa-
jas.
PALABRAS CLAVE: Coronas temporales. Coronas metli- KEY WORDS: Temporary crowns. Metal crowns. Stainless
cas. Coronas de acero inoxidable. Coronas estticas. Restaura- steel crowns. Aesthetic crowns. Restorations in pediatric den-
ciones en odontopediatra. Tcnicas restauracin en denticin tistry. Restoration in primary dentition.
temporal.
Vol. 18. N. 3, 2010 EVOLUCIN DE LAS CORONAS COMO MATERIAL DE RESTAURACIN EN DENTICIN TEMPORAL 187
salud gingival y sin provocar reabsorcin alveolar. Las areas estrechas y unos mecanismos de proteccin
extensiones axiales de las coronas preformadas deben inmaduros. Aunque la aspiracin de dientes y restaura-
replicar las dimensiones y el contorno de la forma origi- ciones es un hecho poco frecuente en la prctica dental,
nal del diente. La pobre adaptacin de los mrgenes siempre existe este peligro. Suele suceder al cementar
puede afectar a la erupcin de los dientes adyacentes, coronas o incrustaciones, pudiendo ser minimizado gra-
adems de a los tejidos periodontales asociados (21,22). cias al uso del dique de goma (28).
Por ello, en funcin de la buena adaptacin de la coro-
na, la salud gingival estar preservada (19). Guelmann y
cols. (23) concluyen que la presencia de una corona de CORONAS OPEN-FACED
acero inoxidable en un segundo molar temporal no afec-
ta la salud periodontal del molar permanente adyacente Hay consideraciones estticas a tener en cuenta con
siempre que la corona sea bien adaptada. las coronas de acero inoxidable. Segn Soxman (12),
Mientras se mantenga una higiene oral adecuada y se muchos padres, casi nunca los nios, muestra insatisfac-
preserve el estrecho contacto entre molares, se minimi- cin con la apariencia de la corona metlica.
zar la reabsorcin alveolar causada por la extensin y Los avances en materiales restauradores y adhesin a
adaptacin marginal (19). Sin embargo, los pacientes metales han hecho posibles nuevas tcnicas que combi-
con mala higiene oral, tendrn mayor probabilidad de nan las ventajas de las coronas metlicas con la esttica
padecer gingivitis alrededor de dichas coronas metli- del composite. Helpin (29), en los aos 80, describi un
cas. Como afirm Randall (18), en el tratamiento de mtodo para proporcionar mejor apariencia a las coro-
pacientes peditricos con coronas, debemos pautar nas metlicas. Su tcnica consista en cortar una ventana
como rutina diaria un rgimen preventivo que incluya por vestibular en la corona cementada, crear retencin
instrucciones de higiene oral para evitar problemas de mecnica, y adherir composite del mismo color del
salud periodontal. diente en la regin expuesta. Sin embargo, esta prctica,
La preparacin del molar para la colocacin de coro- aunque supuso avances en cunto a apariencia, requera
nas es conservadora, siendo las superficies bucal y lin- mucho tiempo de trabajo y los mrgenes de metal per-
gual las ms respetadas. La retencin se obtiene de la sistan perceptibles. A estas coronas las llamaron open
flexibilidad de los mrgenes delgados y contorneados faced y son consideradas la alternativa semiesttica a
de la misma corona (22,24). las coronas metlicas (7).
La correcta oclusin y el contacto interproximal El xito de las open-faced se debe a (30):
resultan difciles de conseguir en los casos en que se ha 1. La firme adhesin al diente remanente.
perdido espacio a causa de lesiones interproximales 2. El uso de adhesin dentinaria.
(22). 3. El grabado cido.
En el momento de la colocacin de las coronas, hay Autores como Wiedenfeld y cols. (31) describen otra
autores que optan por una tcnica diferente a la conven- tcnica eficiente para el tratamiento de dientes anterio-
cional, la tcnica Hall (12,25): res con resultados estticos y duraderos. La tcnica con-
La tcnica convencional requiere la colocacin bajo siste en arenar la superficie de la corona anterior con
anestesia local, remocin completa de la caries, reduc- xido de almina, para posteriormente aplicar un opaci-
cin dental por distal, mesial y oclusal, y tras esto, ajus- ficador, un sellante y composite de un 1mm de grosor.
tarlas, contornearlas y pulirlas, si fuese necesario, antes Es una tcnica que se puede realizar en 3-5 min, pudien-
de cementar. Mientras que la tcnica Hall consiste en do ser aplicada por el personal auxiliar, estando disponi-
escoger correctamente la medida de la corona, llenarla bles los materiales necesarios en las clnicas dentales.
de cemento de ionmero de vidrio y cementarla al Con esta tcnica se obtiene una esttica excelente y una
molar temporal por presin digital o bien por la fuerza buena fuerza de adhesin de 24.4 Mpa.
oclusal del nio, sin anestesia local. Segn Hall es una
tcnica rpida y fcil, bien aceptada por padres y nios.
No se hace remocin parcial de caries sino que se sella CORONAS PREFORMADAS CON FRENTE
la caries con la corona (21). ESTTICO
Su nica contraindicacin para usarla es en caso de
que la caries afecte a borde marginal, debido a que en En la sociedad actual, son muchos los padres que
esos casos la pulpa suele encontrarse afectada (25). demandan restauraciones an ms estticas, prefiriendo
Con la tcnica Hall, Innes y cols. (25) obtuvieron un en algunos casos la exodoncia a la apariencia nada
xito del 73,4% a los 3 aos y del 67.6% a los 5 aos. atractiva de las coronas metlicas en los dientes de sus
Los resultados son similares a los que se pueden obtener hijos (5).
usando otras restauraciones convencionales (26). Aun Las restauraciones que estn ganando popularidad
as, la tcnica Hall requiere ms evaluaciones y ensayos son las coronas con frente esttico. Estas fueron desa-
clnicos longitudinales (25). rrolladas y fabricadas para dientes anteriores primarios
Roberts y Sheriff (27) determinaron que la razn ms en los aos 90: Cheng Crowns, Kinder Krowns, NuS-
comn de fracaso de las coronas es el desgaste de la mile Primary Crown, Whiter Biter II Crown y The
cara oclusal, permitiendo la perforacin de la superficie; Dura Crown (5,32). Se caracterizan por adherir compo-
incluso cundo en la colocacin de la corona se ha teni- site o resina termoplstica a la superficie vestibular de
do en cuenta las relaciones oclusales del diente a tratar. la tradicional corona de acero inoxidable. Su principal
Por otro lado, es importante tener en cuenta que los ventaja es que conservan la esttica, independientemen-
nios de corta edad se caracterizan por tener unas vas te de la humedad y del sangrado (10,33).
07. MM VIROLES:Maquetacin 1 28/2/11 09:29 Pgina 188
Vol. 18. N. 3, 2010 EVOLUCIN DE LAS CORONAS COMO MATERIAL DE RESTAURACIN EN DENTICIN TEMPORAL 189
Es importante recordar que en la prctica clnica es inaceptables a nivel esttico, debido a que adquirirn
necesario adaptar la corona que va a ser colocada para una tonalidad ms oscura.
obtener un buen ajuste pasivo. Previamente, deben pro- La esttica se ver influenciada por el nmero de
barse varios tamaos de coronas para determinar cul se superficies con caries, debiendo tener en cuenta que la
adapta mejor; una vez encontrado el tamao adecuado, contraccin de la resina en un 2-3%, puede comprome-
las coronas no cementadas son esterilizadas (2). ter la adhesin y el sellado de las restauraciones directas
Los diferentes mtodos de esterilizacin pueden (20).
afectar el color y la resistencia a la fractura de la corona Por otro lado, las coronas de acetato muestran serios
(2,5). La presin y las altas temperaturas de la esterili- inconvenientes como: ser una tcnica muy sensible,
zacin pueden destruir la capa de resina adherida, afec- necesitar un control mximo de la humedad para no
tando a la adhesin y alterando su coloracin (2,15,34). alterar la adhesin o el color, requerir cooperacin por
Wickersham y cols. (2) comprobaron la resistencia a parte del paciente y necesitar estructura dental suficien-
la fractura de coronas con frente esttico de diferentes te para la correcta adhesin (5,34,39,41).
marcas comerciales para dientes anteriores, observando Por ello, no pueden ser utilizadas en dientes con
que las coronas Kinder Krowns (Mayclin Laboratory, caries importantes y/o con poca estructura remanente, ni
Minneapolis, Minn) sufren una disminucin de su resis- en caso de caries subgingival, y menos an, en presen-
tencia con esterilizacin al fro. Sin embargo, no obser- cia de enfermedad periodontal o en pacientes con sobre-
varon diferencias significativas en cuanto a los tipos de mordida aumentada (5).
fracturas, a los diferentes fabricantes ni a los distintos A su vez, un inconveniente importante es la dificul-
mtodos de esterilizacin. tad de colocacin, especialmente en pacientes con
Las coronas NuSmile (Orthodontic Technologies caries paragingival o con sangrado gingival, frecuente-
Inc, Houston, TX) ofrecan mayor resistencia que el res- mente asociado a la remocin de la caries y a la prepara-
to, aunque podan mostrar cambios de coloracin, del cin del diente. El composite debe ser adherido con un
mismo modo que las Kinder Krowns. Wickersham y completo control del sangrado y fluido sulcular para
cols. (2) concluyeron que la mejor esterilizacin para no prevenir la contaminacin marginal (5).
daar las coronas era la esterilizacin al fro con glute- El tiempo de trabajo para la colocacin de coronas de
raldehido. acetato es importante en nios y preescolares. En el
caso de las coronas de acetato, el tratamiento suele ser
largo, y los nios, independientemente de si estn seda-
CORONAS DE ACETATO dos o no, tienen dificultad para tolerar perodos largos
de tratamiento, siendo deseable cualquier mtodo que
Para restaurar dientes anteriores temporales tambin tenga menor duracin (40).
existen las coronas de acetato. Son consideradas como En ocasiones, se observa inflamacin alrededor de la
coronas, pese a ser un herramienta para poder realizar resina colocada con la corona de acetato, siendo atribui-
restauraciones coronales. Con estas se consigue realizar da normalmente a (3):
restauraciones con mejor esttica, aunque tambin pose- 1. Acumulacin de placa a nivel cervical.
en inconvenientes (4,34,39). 2. La mala adaptacin de los mrgenes de la restau-
El color y su estabilidad se consideran aceptables, racin, observado a nivel radiogrfico.
mostrndose sin diferencias a los 18 meses de la coloca-
cin. Radiogrficamente, en los mrgenes de las coro-
nas se encuentran frecuentemente pequeas reas de CORONAS DE POLICARBONATO
radiolucidez; no obstante, es imposible determinar si
esta radiolucidez representa caries recurrente, mrgenes Otra opcin para restaurar dientes temporales ante-
cortos o bien, una fina capa de agente adhesivo (3). riores son las coronas de policarbonato. Estas son coro-
La tcnica para realizar restauraciones mediante nas prefabricadas para dientes anteriores, de varios
coronas de acetato consiste en eliminar la caries del tamaos permitiendo escoger el adecuado para cada
diente afectado, bajo aislamiento absoluto, y una vez diente, aunque actualmente no se encuentran con facili-
finalizado, seleccionar el tamao de la corona de aceta- dad en el mercado. Su uso requiere un amplio desgaste
to. Posteriormente, se efecta el grabado cido, la colo- de la superficie dentaria, por esta razn suele indicarse
cacin de adhesivo y la fotopolimerizacin, al mismo para rehabilitar dientes con caries rampante con gran
tiempo que, fuera de boca, se llena la corona de acetato prdida de tejido dental (43).
con resina. Despus se coloca en el diente a tratar, se Autores como Webber y cols. (43) determinaron que
polimeriza y se retira la misma corona, dejando la resina las coronas de acetato son ms estticas, muestran
adherida al diente (40). mejor retencin y resistencia al desgaste en compara-
Las coronas de acetato tienen una retencin a los 1,5- cin con las coronas de policarbonato.
2 aos del 83%, y del 78% a los 3 aos (3,41). Por ello,
en el momento de escoger la restauracin, es importante
determinar cunto tiempo resta para la exfoliacin del DISCUSIN
diente a tratar.
Dichas coronas parecen tener pocos efectos negati- Desde que en los aos 50 Humphrey (17) introdujera
vos para la salud pulpar. Aunque, segn Oldenburg y las coronas preformadas de acero-cromo, el aspecto
cols. (42), si el diente previamente ha recibido trata- esttico de las restauraciones coronales ha mejorado
miento pulpar, probablemente se obtendrn resultados notablemente, hasta las coronas preformadas con frente
07. MM VIROLES:Maquetacin 1 28/2/11 09:30 Pgina 190
esttico actuales. El uso de las coronas estticas en sec- La bsqueda de una esttica ptima se ha convertido
tor posterior est indicado en las mismas situaciones en en uno de los objetivos principales en la odontologa
las que se usan las coronas de acero inoxidable conven- restauradora, independientemente de la denticin en la
cionales, aunque el tallado para las coronas estticas es que se est trabajando. Debido a que la decisin final
ms agresivo. sobre la restauracin a colocar, en el caso de denticin
A nivel anterior, se pueden escoger diferentes opcio- temporal, la tienen los padres, es importante conocer su
nes para restaurar los incisivos temporales, ya que exis- satisfaccin con las restauraciones estticas existentes.
te una variedad de coronas que ofrecen soluciones a los Hasta la fecha, slo hemos encontrado en la literatura
problemas de caries o traumatismos en esos dientes. tres estudios (4,6,10) que tienen como objetivo compa-
Mientras que en el sector posterior, no hay tanta varie- rar el grado de satisfaccin de los padres. Estos evalua-
dad de coronas para escoger. ron la respuesta de los familiares o tutores frente a la
Las coronas preformadas con frente esttico se dise- apariencia de las coronas con frente esttico para dien-
aron para resolver los problemas asociados a las coro- tes anteriores.
nas de acetato y/o a las open-faced (36). Las diseadas Cada uno de ellos us una marca comercial distinta.
para el sector posterior, llevan pocos aos en el mercado Roberts y cols. (4) describieron la longevidad, fracaso y
y los estudios al respecto muestran resultados que cues- satisfaccin de las coronas Whiter Biter II (Whiter
tionan su uso a nivel clnico (35,38). Las primeras coro- Biter Inc, La Grange, KY). Shah y cols. (6) hicieron lo
nas con frente esttico fabricadas para molares tempora- mismo con las coronas Kinder Krowns, mientras que
les mostraban inconvenientes relevantes como Champagne y cols. (10), nicamente evaluaron la satis-
afectacin de la salud gingival, alto coste, volumen faccin de los padres para las coronas NuSmile.
excesivo y deterioro del frente esttico o fractura del La retencin fue del 100% en todos los estudios,
mismo a los pocos meses (35). aunque la fractura total de la parte esttica se observ
Champagne y cols. (10) determinaron que la satisfac- en un 24% para las Whiter Biter II, en un 13% para
cin de los padres era mayor con las coronas preforma- las Kinder Krowns, y en menos de un 1% para las
das con frente esttico, ya que a diferencia de las coro- NuSmile; cabe destacar que la muestra de este ltimo
nas open-faced, el metal no era visible en una distancia estudio era 4 veces superior a los otros dos estudios
de conversacin. Por otro lado, Yilmaz y Koogullari (Tabla II).
(30) compararon ambas coronas durante 18 meses, En relacin a la satisfaccin de los padres, los tres
obteniendo un xito de supervivencia para las open- estudios obtuvieron resultados similares, siendo la pun-
faced del 95%; mientras que para las preformadas con tuacin ms negativa para la apariencia y el color, y la
frente esttico fue del 80%. Es importante destacar que ms positiva para el tamao y la forma de las coronas.
estos resultados no fueron estadsticamente significati- La satisfaccin de los padres fue elevada, en la
vos, aunque si que fue estadsticamente significativo el mayora de casos afirmando que escogeran las mismas
hecho de que todos los fracasos se produjeran en la coronas preformadas con frente esttico para sus hijos si
arcada inferior. Determinaron que el mayor xito de las fuera necesario. Sin embargo, algunos padres anotaron
open-faced era debido a la firme adhesin entre resina y que las coronas parecan tener un color ms blanco que
tejido, al uso del adhesivo dentinario y al grabado cido, el diente adyacente, hecho que les desagradaba (10).
ya que permitan mejor adhesin de la resina. Las coro- Actualmente, la marca comercial NuSmile ofrece un
nas open-faced, an evidenciando mayor xito, sufrie- segundo tono, de aspecto menos blanquecino y aparien-
ron cambios importantes en su esttica. cia ms natural.
TABLA II
ESTUDIOS CUYO OBJETIVO FUE EVALUAR LA SATISFACCIN DE LOS PADRES SOBRE LAS CORONAS PREFORMADAS
CON FRENTE ESTTICO PARA SECTOR ANTERIOR
Autor/ Objetivo Coronas Muestra Tiempo Satisfaccin Fractura Fractura Valoraciones Valoraciones
Ao evaluacin parcial total negativas positivas
esttica
Roberts et al Evaluar el xito Whiter Biter II 35 coronas Media de 8,9 puntos 3 (8%) 9 (24%) Apariencia y color Tamao y forma
2000 clnico y la aceptacin (ahora conocidas 12 pacientes 20,7 meses sobre 10
de los padres de las como Dura Crowns)
coronas estticas para dientes anteriores
Shah et al Evaluar el xito Kinder Krowns 46 coronas Media de 21 puntos de 5 (11%) 6 (13%): Apariencia (fractura Tamao y forma
2004 clnico y la satisfaccin para dientes anteriores 12 padres-nio 17,3 meses 25 posibles 4ICS,1ILS, esttica, color
de los padres de las De 2 a 6 1CS y desgaste)
coronas estticas coronas/paciente
Champagne Evaluar la satisfaccin NuSmile para 238 coronas Mnimo 6 meses 93% 27 (11%) 6 (< 1%) Visibilidad del Tamao y forma
et al 2007 de los padres de las dientes anteriores 54 padres-nios (Media de 13 m) (50 padres de metal y duracin
coronas estticas 1 corona/paciente 54 posibles)
como mnimo
07. MM VIROLES:Maquetacin 1 28/2/11 09:30 Pgina 191
Vol. 18. N. 3, 2010 EVOLUCIN DE LAS CORONAS COMO MATERIAL DE RESTAURACIN EN DENTICIN TEMPORAL 191
Los padres puntuaron a las coronas con un 8,9/10 y incisivas. La fuerza necesaria para fracturar el frente
un 8,4/10 en el estudio de Roberts y cols. (4) y en el de esttico es de 510.11 N en caso de coronas no contorne-
Shah y cols. (6), respectivamente. Para las NuSmile, la adas y de 511.02 N para las contorneadas. En todo caso,
satisfaccin general fue ligeramente superior, alcanzan- es muy superior a la media de la fuerza de masticacin
do el 93% de la muestra. de un nio de 5-10 aos, que suele ser de 375 N (1,7).
En general, las variables que mostraron diferencias Por otro lado, debemos tener en cuenta ciertos facto-
ms significativas en cuanto a satisfaccin fueron (10): res destacables que pueden provocar un fracaso del
El gnero del nio. frente esttico, como es el caso del resalte. Nios con
Las opciones futuras de tratamiento. resaltes aumentados (> 6 mm), fcilmente pueden expe-
La satisfaccin percibida por los nios. rimentar traumatismos y, en consecuencia, tienen
Los padres se mostraban menos satisfechos si el mayor probabilidad de experimentar fracasos en la
gnero del paciente era masculino. Y a su vez, las interfase resina-metal. Por el contrario, la sobremordida
madres resultaban mucho ms crticas con el tratamien- aumentada no est estrechamente asociada con un
to que los padres. Tambin se observ que la satisfac- aumento del desgaste del frente esttico (4,6). De modo
cin de los padres era directamente proporcional a la que se determina que la oclusin es un factor a tener en
satisfaccin mostrada por el nio (10). cuenta para pronosticar el xito del tratamiento.
Por otro lado, uno de los mayores inconvenientes que Estudios como el de Baker y cols. (34) evalan la
muestran las coronas preformadas con frente esttico es fuerza necesaria para fracturar, dislocar o deformar el
el riesgo de fractura y en consecuencia, la prdida de frente esttico de coronas preformadas con frente estti-
esttica. Por ello, los fabricantes determinaron limitar el co de distintas casas comerciales. En sus resultados se
contorneado de dichas coronas. Debido a la controver- observa que las ms resistentes son las Cheng Crowns.
sia sobre contornear o no, aparecieron estudios como el Otras, como NuSmile y Kinder Krowns, sufren fractu-
de Gupta y cols. (7) dnde se comparaba la resistencia a ras parciales/totales del frente esttico, atribuyendo el
la fractura del frente esttico entre un grupo de coronas resultado a los diferentes materiales empleados por cada
contorneadas y otro que no. Aunque las coronas contor- fabricante.
neadas mostraron mayor tendencia de prdida de la resi- Los procesos de reparacin estudiados son fciles y
na, tenan menor intervalo de distribucin de las fractu- rpidos de aplicar. Adems, el odontlogo no necesita
ras; mientras que las no contorneadas tenan resultados retirar la corona y colocar otra para repararla (34), pero
muy dispares. Es importante destacar que el frente est- se debe tener en cuenta que los materiales de reparacin
tico se separaba de la interfase metal-resina pero nunca ofrecen menor resistencia que el material original del
quedaba totalmente descolocada. frente esttico (32) (Tabla III).
La causa de la fractura del frente esttico es, proba- Tambin Yilmaz y cols. (44) obtuvieron resultados
blemente, debida a fuerzas traumticas, y no a fuerzas similares. Evaluaron la fuerza de adhesin del material
TABLA III
ESTUDIOS QUE EVALAN LA RESISTENCIA IN VITRO A LA FRACTURA DE LAS CORONAS PREFORMADAS CON FRENTE
ESTTICO PARA SECTOR ANTERIOR Y POSTERIOR
Autor/ Objetivo Coronas/ Marcas Ciclos Mquina Velocidad Fuerza de Tipo de
Ao Muestra fractura fractura
Baker et al Determinar la resistencia Coronas anteriores Cheng Crowns, En agua 90 das, Mquina test 0,05 in/min Cheng Crowns Fractura, descolo-
1996 a la fractura de 4 de incisivos Kinder Krowns, termocicladas entre mecnico (Instron, = 107.8 pounds cacin y deforma-
marcas de coronas centrales superiores Whiter Bitter II, 4 y 55C, 500 Canton, MA, NuSmile = cin
estticas N = 40 NuSmile ciclos, 45" ciclo EE.UU.) de 100.2 pounds
0,5 mm de grosor Kinder Krowns
y 9 mm de altura = 91.3 pounds
con un ngulo Whiter Biter II
de 148 = 81.5 pounds
Yilmaz y Determinar la fuerza Coronas anteriores NuSmile En agua un ao, Test mecnico 0,05 pulgadas/min 385 N* No especifica
Yilmaz necesaria para la para incisivos ya reparadas, (Hounsfield, Raydon,
2004 dislocar chapa centrales superiores entre 4-55 C, England) 0,5 mm
esttica N = 16 250 ciclos, de grosor, y 8 mm
20"ciclo ancho, con un
ngulo de 148
Yilmaz et al Determinar la fuerza Coronas posteriores NuSmile En ambiente hmedo No especifica 1,5 mm/min 870.6N* Fuerza de masticacin
2008 de adhesin de la de molares temporales a 37 C durante de los nios = 375 N*
chapa esttica y de maxilares y 30 das, termoci-
2 materiales de mandibulares cladas entre 4-55 C,
reparacin N = 22 500 ciclos
*1 Newton equivale a 0.225 pounds.
07. MM VIROLES:Maquetacin 1 28/2/11 09:30 Pgina 192
original del frente esttico y de dos materiales de repa- 9. Guideline on pediatric restorative dentistry. Pediatr Dent 2008;
racin diferentes. Obtuvieron que la fuerza de adhesin 30(7 Suppl): 163-9.
10. Champagne C, Waggoner W, Ditmyer M, Casamassimo PS,
del material original (870.6 N) era ligeramente superior MacLean J. Parental satisfaction with preveneered stainless ste-
a la fuerza de los dos materiales reparadores (834.3 N el crowns for primary anterior teeth. Pediatr Dent 2007; 29(6):
para el grupo 1 y 763.2 N para el grupo 2), sin existir 465-9.
diferencias significativas entre estos dos grupos. 11. Attari N, Roberts JF. Restoration of primary teeth with crowns:
a systematic review of the literature. Eur Arch Paediatr Dent
2006; 7(2): 58-62.
CONCLUSIONES
12. Soxman JA. Stainless steel crown and pulpotomy: procedure
and technique for primary molars. Gen Dent 2000; 48(3): 294-
7.
La creciente demanda de esttica a nivel dental para 13. Crawford PJ, Aldred M, Bloch-Zupan A. Amelogenesis imper-
fecta. Orphanet J Rare Dis 2007; 2: 17.
la poblacin infantil por parte de nios y padres sobre- 14. Nash DA. The nickel-chromium crown for restoring posterior
todo, hace que los materiales de restauracin estn en primary teeth. J Am Dent Assoc 1981; 102(1): 44-9.
constante cambio. Las coronas son la restauracin que 15. Croll TP, Helpin ML. Preformed resin-veneered stainless steel
ofrece mejores resultados y sus avances en esttica son crowns for restoration of primary incisors. Quintessence Int
1996; 27(5): 309-13.
importantes para dicha poblacin. 16. Engel RJ. Chrome steel as used in children's dentistry. Chron
A pesar de las desventajas de las coronas preforma- Omaba Dist Dent Soc 1950; 13: 255-8.
das con frente esttico, en general, existe una gran satis- 17. Humphrey WP. Uses of chrome steel crown in children den-
faccin de los padres por su apariencia, color, forma y tistry. Dental Survey 1950; 26: 945-9.
tamao. En el caso de las de sector posterior, en la lite- 18. Randall RC. Preformed metal crowns for primary and perma-
nent molar teeth: review of the literature. Pediatr Dent 2002;
ratura revisada no hemos encontrado estudios que ten- 24(5): 489-500.
gan como objetivo principal evaluar la satisfaccin de 19. Sharaf AA, Farsi NM. A clinical and radiographic evaluation of
los padres. Es necesario comprobar el funcionamiento stainless steel crowns for primary molars. J Dent 2004; 32(1):
correcto de las coronas con frente esttico para dientes 27-33.
20. Updyke J, Sneed WD. Placement of a preformed indirect resin
posteriores y compararlas con los resultados obtenidos composite shell crown: a case report. Pediatr Dent 2001; 23(2):
con las coronas metlicas. Y a su vez, valorar la satis- 143-4.
faccin de los padres al respecto, para en un futuro, pro- 21. Croll TP, Epstein DW, Castaldi CR. Marginal adaptation of
mover su uso. stainless steel crowns. Pediatr Dent 2003; 25(3): 249-52.
22. JR Boj, Ustrell JM. Evaluacin de la calidad y funcionalidad de
las coronas de acero inoxidable en molares primarios. Rev Eur
Odontoestomal 1991; 3(5): 343-6.
23. Guelmann M, Matsson L, Bimstein E. Periodontal health at first
permanent molars adjacent to primary molar stainless steel
CORRESPONDENCIA:
crowns. J Clin Periodontol 1988; 15(9): 531-3.
Francisco Guinot Jimeno
24. Randall RC, Vrijhoef MM, Wilson NH. Efficacy of preformed
Universitat Internacional de Catalunya
metal crowns vs. amalgam restorations in primary molars: a
Facultad de Odontologa
systematic review. J Am Dent Assoc 2000; 131(3): 337-43.
Departamento de Odontopediatra
25. Innes NP, Stirrups DR, Evans DJ, Hall N, Leggate M. A novel
Hospital General de Catalunya
technique using preformed metal crowns for managing carious
Josep Trueta, s/n. 08190
primary molars in general practice - a retrospective analysis. Br
08190 St. Cugat del Valls (Barcelona)
Dent J 2006; 200(8): 451-4.
e-mail: fguinot79@hotmail.com
26. Chadwick B, Dummer P, Dummer F. How long do fillings
last?. Evidence based Dent 2002; 3: 96-9.
27. Roberts JF, Sherriff M. The fate and survival of amalgam and
preformed crown molar restorations placed in a specialist pae-
diatric dental practice. Br Dent J 1990; 169(8): 237-44.
BIBLIOGRAFA
28. Adewumi A, Kays DW. Stainless steel crown aspiration during
sedation in pediatric dentistry. Pediatr Dent 2008; 30(1): 59-62.
29. Helpin ML. The open-face steel crown restoration in children.
1. Waggoner WF. Restoring primary anterior teeth. Pediatr Dent ASDC J Dent Child 1983; 50(1): 34-8.
2002; 24(5): 511-6. 30. Yilmaz Y, Kocogullari ME. Clinical evaluation of two different
2. Wickersham GT, Seale NS, Frysh H. Color change and fracture methods of stainless steel esthetic crowns. J Dent Child 2004;
resistance of two preveneered stainless-steel crowns after steri- 71(3): 212-4.
lization. Pediatr Dent 1998; 20(5): 336-40. 31. Wiedenfeld KR, Draughn RA, Welford JB. An esthetic techni-
3. Kupietzky A, Waggoner WE, Galea J. Long-term photographic que for veneering anterior stainless steel crowns with composite
and radiographic assessment of bonded resin composite strip resin. ASDC J Dent Child 1994; 61(5-6): 321-6.
crowns for primary incisors: results after 3 years. Pediatr Dent 32. Yilmaz Y, Yilmaz A. Repairing a preveneered stainless steel
2005; 27(3): 221-5. crown with two different materials. J Dent Child 2004; 71(2):
4. Roberts C, Lee JY, Wright JT. Clinical evaluation of and paren- 135-8.
tal satisfaction with resin-faced stainless steel crowns. Pediatr 33. MacLean JK, Champagne CE, Waggoner WF, Ditmyer MM,
Dent 2001; 23(1): 28-31. Casamassimo P. Clinical outcomes for primary anterior teeth
5. Croll TP. Primary incisor restoration using resin-veneered treated with preveneered stainless steel crowns. Pediatr Dent
stainless steel crowns. ASDC J Dent Child 1998; 65(2): 89-95. 2007; 29(5): 377-81.
6. Shah PV, Lee JY, Wright JT. Clinical success and parental 34. Baker LH, Moon P, Mourino AP. Retention of esthetic veneers
satisfaction with anterior preveneered primary stainless steel on primary stainless steel crowns. ASDC J Dent Child 1996;
crowns. Pediatr Dent 2004; 26(5): 391-5. 63(3): 185-9.
7. Gupta M, Chen JW, Ontiveros JC. Veneer retention of prevene- 35. Fuks AB, Ram D, Eidelman E. Clinical performance of esthetic
ered primary stainless steel crowns after crimping. J Dent Child posterior crowns in primary molars: a pilot study. Pediatr Dent
2008; 75(1): 44-7. 1999; 21(7): 445-8.
8. Seale NS. The use of stainless steel crowns. Pediatr Dent 2002; 36. Waggoner WF, Cohen H. Failure strength of four veneered pri-
24(5): 501-5. mary stainless steel crowns. Pediatr Dent 1995; 17(1): 36-40.
07. MM VIROLES:Maquetacin 1 28/2/11 09:30 Pgina 193
Vol. 18. N. 3, 2010 EVOLUCIN DE LAS CORONAS COMO MATERIAL DE RESTAURACIN EN DENTICIN TEMPORAL 193
37. Flaitz CM, Agostini F. Gingival disease associated with a deco- posite strip crowns in primary incisors: a retrospective study.
rative crown. Pediatr Dent 2002; 24(1): 47-9. Int J Paediatr Dent 2006; 16(1): 49-54.
38. Ram D, Fuks AB, Eidelman E. Long-term clinical performance 42. Oldenburg TR, Vann WF Jr., Dilley DC. Composite restora-
of esthetic primary molar crowns. Pediatr Dent 2003; 25(6): tions for primary molars: results after four years. Pediatr Dent
582-4. 1987; 9(2): 136-43.
39. Kupietzky A. Bonded resin composite strip crowns for primary 43. Webber DL, Epstein NB, Wong JW, Tsamtsouris A. A method of
incisors: clinical tips for a successful outcome. Pediatr Dent restoring primary anterior teeth with the aid of a celluloid crown
2002; 24(2): 145-8. form and composite resins. Pediatr Dent 1979; 1(4): 244-6.
40. Croll TP. Bonded composite resin crowns for primary incisors: 44. Yilmaz Y, Gurbuz T, Eyuboglu O, Belduz N. The repair of pre-
technique update. Quintessence Int 1990; 21(2): 153-7. veneered posterior stainless steel crowns. Pediatr Dent 2008;
41. Ram D, Fuks AB. Clinical performance of resin-bonded com- 30(5): 429-35.
Review
ABSTRACT RESUMEN
Composites, dental amalgam and preformed metal crowns Entre los materiales restauradores disponibles ms usados
are the most widely used restorative materials in paediatric en odontopediatra encontramos: los composites, la amalgama
dentistry. Composite is the material of choice for restoring y las coronas metlicas preformadas. El composite es el mate-
type I, II and V cavities in the two dentitions. However, the rial de eleccin cuando se trata de restaurar cavidades tipo I, II
preformed metal crown is the best option when there are 3 or y V en ambas denticiones. Sin embargo, cuando se ven invo-
more surfaces involved. lucradas 3 o ms superficies, la mejor opcin son las coronas
At present, two groups of crowns are used in paediatric metlicas preformadas.
dentistry: metal crowns and aesthetic crowns. Within these Actualmente, existen dos grandes grupos de coronas en
two groups, there are a number of types with different proper- odontopediatra: las coronas metlicas y las estticas. Dentro
ties, depending on the location in the dental arch to be de cada grupo, podemos encontrar diferentes tipos en funcin
restored. de la situacin en la arcada del diente a restaurar, o de las pro-
This review aims to analyze the evolution of crowns as a piedades que necesitemos.
restorative material in primary teeth and their properties, El objetivo de esta revisin bibliogrfica es analizar la evo-
advantages and drawbacks. lucin de las coronas como material de restauracin en denti-
cin temporal, as como sus propiedades, ventajas y desventa-
jas.
KEY WORDS: Temporary crowns. Metal crowns. Stainless PALABRAS CLAVE: Coronas temporales. Coronas metli-
steel crowns. Aesthetic crowns. Restorations in pediatric den- cas. Coronas de acero inoxidable. Coronas estticas. Restaura-
tistry. Restoration in primary dentition. ciones en odontopediatra. Tcnicas restauracin en denticin
temporal.
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of these crowns (18) making them the best restorative need for local anesthesia. According to Hall it is a quick
option for severely damaged primary molars (19). and easy technique that both children and parents accept
Previously crowns consisted of indirect restorations well. There is no partial removal of the caries as these
that required impression taking, staining and, for the are sealed with the crown (21).The only contraindica-
correct size to be made, a laboratory had to be involved. tion for using this technique is if the caries affects the
Years later, when preformed crowns appeared, the cost marginal ridge, as in these cases the pulp tends to be
of the procedure was reduced. With the direct method, affected (25).
clinical time was also reduced, which helped with the Innes et al.(25) had a success rate with the Hall
management of difficult patients (20). technique of 73.4% at three years, and of 67.6% at 5
Preformed crowns required less adjustment to years. These results are similar to those of other con-
achieve a precise fit for a prepared tooth, but with care- ventional restorations (26). However, the Hall tech-
ful handling, all crowns could be adapted properly. The nique requires further longitudinal clinical trials and
final adjustment phase should be carried out by the den- evaluations (25).
tist, who should obtain the marginal adaptation of the Roberts and Sheriff (27) established that the most
individual dental preparation. Metal crowns with shapes common reason for a crown failing was wear to the
that match and adapt to margins, and which do not occlusal surface, leading to the perforation of this sur-
require the dentist to carry out any type of adjustment, face even when the occlusal relationship of the tooth
are unknown (21). being treated had been taken into account.
Metal crowns are indicated for primary molar Furthermore, it is important to keep in mind that
restorations as gingival health is not directly affected young children are known to have narrow airways and
and they do not lead to alveolar ridge resorption. The immature protective mechanisms. Although the aspi-
axial extension of preformed crowns should have the ration of teeth and restorations is unusual in dental
same dimension and outline of the original shape of the practice, the danger does exist. It tends to occur on
tooth. Poor marginal adaptation can affect the eruption cementing crowns, inlays and onlays, but this risk can
of adjacent teeth, and associated periodontal tissues be minimized by using a rubber dam (28).
(21,22). Therefore, the preservation of healthy gingiva
will depend on the adapting the crown properly (19).
Guelmann et al (23) concluded that the presence of a
stainless steel crown on a second primary molar does OPEN-FACE CROWNS
not affect the periodontal health of the adjacent perma-
nent molar, providing the crown has been properly There are esthetic considerations to be kept in mind
adapted. with stainless steel crowns. According to Soxman (12),
Providing adequate oral hygiene is observed and the many parents, but rarely children, show dissatisfaction
close contact between molars is preserved, alveolar with the appearance of a metal crown.
ridge resorption caused by the marginal adaptation and The advances in restoration materials and metal
extension will be minimized (19). However, patients bonding have led to new techniques being possible
with bad oral hygiene will have a greater probability of which combine the advantages of metal crowns with the
suffering gingivitis around these metal crowns. As Ran- esthetic qualites of composite. Helpin (29) in the 80s
dall affirmed (18) when treating pediatric patients with described a method that improved the appearance of
crowns, instructions should be given on a daily routine metal crowns. The technique consisted in performing a
of a preventative nature that includes oral hygiene rec- buccal window in the cemented crown for mechanical
ommendations so that periodontal health problems are retention, and the bonding of composite the same color
avoided. as the tooth in the exposed region. However, while this
Conservative preparation is required when placing technique improved the appearance, it required a lot of
a crown on a molar tooth and the buccal and lingual chair time and the metal margins could still be seen.
surfaces are the least touched. Retention is achieved These were called open-face crowns and they are
as a result of the flexibility of the fine margins and the considered the semi-esthetic alternative to metal crowns
shaping of the crown itself (22,24). Correct occlusion (7).
and interproximal contact are difficult to achieve The success of open-face crowns is due to (30):
when space has been lost due to interproximal lesions 1. The firm bonding to the remaining tooth.
(22). 2. The use of dentin bonding.
There are authors who opt for a different technique to 3. Acid etching.
the conventional one for fitting crowns, such as the Hall Authors such as Wiedenfeld et al. (31) described
technique (12,25). The conventional technique requires another technique for efficiently treating anterior
placement using local anesthesia, the complete removal teeth with both esthetic and lasting results. The tech-
of the caries, the distal, mesial and occlusal reduction of nique consisted of sandblasting the anterior surface of
the tooth, and after this the crown has to be adjusted, the crown with aluminum oxide, after which an
and if necessary shaped and smoothed, before being opaque sealant was applied with composite of a 1mm
cemented. The Hall technique consists in correctly thickness. This technique can be carried out in 3-5
selecting the measurements of the crown. It is then minutes, it can be applied by assistant staff, and all
filled with glass ionomer cement and cemented to the the materials are available in dental clinics. It offers
primary molar by applying pressure with the finger or excellent esthetic results together with a bond strength
by using the occlusal forces of the child, without the of 24.4 Mpa.
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PREFORMED CROWNS WITH ESTHETIC dentistry has been to improve the characteristics of
FACINGS existing restorations in posterior primary teeth: durabili-
ty, natural color, adhesive bonding that is biocompatible
In current society, many parents demand restorations with the pulp, easy fitting and placement in a single vis-
that are even more esthetic, and they sometimes prefer it (38).
an extraction to the unattractiveness of a metal crown in
their childs teeth (5).
The restorations that are gaining in popularity are Posterior region
crowns with an esthetic facing. These were developed
and manufactured for primary anterior teeth in the 90s: Esthetic dentistry has evolved considerably over the
Cheng Crowns, Kinder Krowns, NuSmile Primary last two decades, and composite has become the best
Crown, Whiter Biter II Crown and The Dura Crown option for restoring molars with three severely damaged
(5,32). Composite or thermoplastic resin is bonded to surfaces. Recently a new type of posterior crown has
the buccal surface of the traditional stainless steel appeared on the market providing an esthetic and func-
crown. The main advantage is that they maintain an tional solution for severely damaged primary molars or
esthetic appearance regardless of humidity and bleeding those with pulp treatment (35). These are conventional
(10,33). stainless steel crowns which are given a composite fac-
ing by a laboratory. This esthetic facing covers the buc-
cal, occlusal, mesial and distal surface of the crown
Anterior region with a thickness that varies from 0.6 mm on the mesio-
buccal side to 1.5mm on the occlusal surface (35).
Roberts et al. (4) were the first to describe the clini- Esthetic crowns for primary molars have been on the
cal function of these crowns in primary anterior teeth. market for only a few years, but despite this, they repre-
Their studies suggested that esthetic material bonded to sent a great advancement in the development of full-
the structure gave positive results, although there were coverage restoration materials, and they offer an esthet-
certain problems such as cost, sterilization and resis- ic alternative to conventional crowns (35). The
tance of the esthetic part (2,34-36). difference between esthetic and conventional crown
Crowns with an esthetic facing have a greater thick- techniques is not large, but several points should be kept
ness than metal ones. This increase in volume is due to in mind (35):
the material that has to support the forces of mastication The occlusal reduction in esthetic crowns should
or displacement failures (30). be greater, depending on the manufacturer, in order to
Mc. Lean et al. (33) carried out a retrospective study compensate for the thickness of the facing. This can be
with the aim of evaluating the clinical results of esthetic a problem in primary teeth, as greater occlusal reduction
crowns in the anterior region over a period of 19.2 can lead to pulp exposure, although this is not a problem
months. During this time 86% of the crowns maintained in teeth with pulp treatment.
their anatomy while 14% had a voluminous appearance. Adapting an esthetic crown correctly to the buccal
Nearly all the crowns (99%) were fracture resistant over gingival margin is more difficult given the thick margin
a minimum period of 6 months, but 29% started to show that presses on and irritates the gingival tissue. This is
clear wear. It should be pointed out that the fracture or more difficult given that adjusting the crown in this area
wear of a crown with esthetic facing affects its appear- is impossible. However, on occasions it can be adjusted
ance and this reduces parental satisfaction, but the func- on the proximal and lingual surfaces.
tion of the restoration is not impaired (4). The crowns should be placed on their own. On
The esthetic crowns that are commercially available pressing them or shaping them the stability of the resin
are difficult to shape due to the tendency of esthetic is put at risk.
materials to fracture (35). Some brands advise profes- The final esthetic result does not always please
sionals not to press the crowns in order to avoid frac- parents as these crowns are larger and they have a less
tures. However, Gupta et al (7) claim that many dentists natural appearance.
crimp veneered crowns on the lingual aspect where no The preparation and cementing time is similar to
resin has been bonded in order to achieve a better fit and that of metal crowns although the cost of esthetic
to increase the retention of the crown. crowns is higher.
It is important to mention that from an esthetical Ram and Fuks (35) concluded that esthetic crowns
point of view, different cultures use decorative crowns for posterior teeth had several disadvantages: poor gin-
(gold, three quarters, etc.). These crowns are prefabri- gival health, higher cost, bulky and unnatural appear-
cated and on many occasions they are not even fitted by ance. With regard to gingival health, better periodontal
a dentist, which may lead to considerable complications health was observed at six months with the convention-
such as periodontal disease, dental caries, traumatic al crowns than with the esthetic crowns, but after four
occlusion, fractures, devitalized teeth or contact aller- years there was no difference with regard to periodontal
gies, etc. (37). health (35). This could be due to the gingival tissue
Roberts et al. (4) and Waggoner and Cohen (36), adapting to the thicker margin of the esthetic crown
among others, have carried out research in order to (38).
improve the esthetic aspect in the anterior region, but Ram and Fuks (38) evaluated esthetic crowns for pri-
not the problem of esthetics in the posterior region. mary molars and they obtained similar results to those
Over recent years one of the objectives in pediatric of Roberts et al. (4) in the anterior region. Both investi-
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Vol. 18. N. 3, 2010 DEVELOPMENT OF CROWNS AS RESTORATION MATERIAL FOR PRIMARY TEETH. A REVIEW OF THE LITERATURE 197
gations concluded that the result of esthetic crowns was adhered to the tooth (40).
excellent, despite the high number of failures, problems Acetate crowns have a retention of 1.5-2 years of
with chipping and fractures. 83% and of 78% at 3 years (3,41). Therefore, when the
Although there are limitations regarding the use of restoration is selected it is important to determine how
preformed crowns with esthetic facings, such as the col- much time is left for the exfoliation of the tooth that is
or tones which tend to be very artificial (15), they are to be treated.
the best option on many occasions for restorations, and These crowns appear to have very few negative
they are of great importance in pediatric dentistry if effects on pulp health. Although according to Olden-
improvements are made to reduce the bulkiness and burg et al. (42), if the tooth has previously undergone
thickness of the esthetic facing, so that there is pulp treatment, the results from an esthetic point of
improved bonding between the metal and the facing, view will probably be unacceptable as they will acquire
and if their cost is reduced (38). a darker tone. Esthetically they are influenced by the
It should be remembered that in clinical practice number of surfaces with caries and it should be kept in
adapting the crown is necessary in order to obtain a mind that the resin contracting by 2-3% can jeopardize
good passive fit. Various sizes should be tried before- the adhesion and seal of direct restorations (20).
hand in order to establish which size adapts best. Once However, acetate crowns have serious disadvantages
the best size has been found the crowns that are not in that: the technique is very sensitive, maximum
cemented should be sterilized (2). humidity control is needed so that bonding and color are
The different sterilization methods can affect the col- not disturbed, patient cooperation is required, and there
or and resistance to fracture of the crown (2,5). The should be enough dental structure for correct bonding
pressure and high temperature during sterilization can (5,34,39,41).
destroy the resin-bonded strip, affecting bonding and These crowns cannot therefore be used in teeth with
disturbing the color (2,15,34). extensive caries and/or little remaining structure, nor if
Wickersham et al. (2) evaluated the fracture resis- there are subgingival caries, periodontal disease, nor
tance of crowns with esthetic facing of different brands can they be used in patients with excessive overbite (5).
for the anterior teeth, observing that the crowns by One important disadvantage is the placement diffi-
Kinder Krowns (Mayclin Laboratory, Minneapolis, culty in patient with paragingival caries or gingival
Minn) underwent a decrease in resistance following bleeding, commonly associated with the removal of
cold sterilization. However, significant differences were caries and the preparation of the tooth. The composite
not observed with regard to fracture types, the different should be stuck when there is complete control of the
manufacturers or the different methods of sterilization. bleeding and sulcus fluid in order to avoid marginal
NuSmile crowns (Orthodontic Technologies Inc, contamination (5).
Houston, TX) offered more resistance than the others, The chair time for placing acetate crowns is consid-
although they sometimes showed changes in color as erable in children and preschoolers. With acetate
did the Kinder Krownscrowns. Wickersham et al. (2) crowns, the treatment tends to be lengthy, and the chil-
concluded that the best way of sterilizing, in order not to dren, regardless of whether they are sedated or not, find
harm the crowns, was by using cold sterilization with long treatment times difficult to tolerate, and any
glutaraldehyde. method with a shorter time is desirable (40).
On some occasions, inflammation is observed
around the resin that is placed with the acetate crown
and this is normally attributed to (3):
ACETATE CROWNS 1. Accumulation of plaque by the cervix.
2. Poor marginal adaptation of the restoration which
For restoring primary anterior teeth there are also can be observed radiographically.
acetate crowns. These are considered crowns despite
being a tool enabling the restorations of crowns.
Restorations can be carried out that are more esthetic, POLYCARBONATE CROWNS
although there are certain draw backs (4,34,39). Their
color and stability are considered acceptable, and they Another option for restoring primary anterior teeth is
show no difference 18 months after placement. Radi- the polycarbonate crown. These are prefabricated
ographically, the margins show small areas of radiolu- crowns for the anterior teeth, of various sizes which
cency. Nevertheless it is important to determine if this allow the most suitable one to be selected for each
radiolucency is due to recurrent caries, short margins, or tooth, although currently they are not easily found on
a fine layer of a bonding agent (3). the market. The dental surface has to be reduced consid-
The technique for carrying out restorations using erably and for this reason they tend to be indicated for
acetate crowns consists in eliminating the caries of the the rehabilitation of teeth with rampant caries and
affected tooth, using complete isolation, and once this where there is considerable loss of dental tissue (43).
has been done the size of the acetate crown is selected. Authors such as Webber et al. (43) concluded that
After this acid etching is carried out, adhesive is placed acetate crowns are more esthetic, they have better reten-
and photopolymerization is carried out while, outside tion and they are more wear resistant when compared
the mouth, the crown is filled with resin acetate. It is with polycarbonate crowns.
then placed on the tooth to be treated which is polymer-
ized and the crown itself is removed leaving the resin
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TABLE II
STUDIES THAT WERE AIMED AT EVALUATING THE SATISFACTION OF PARENTS REGARDING PREFORMED CROWNS
WITH ESTHETIC FACING FOR THE ANTERIOR REGION
Author year Objetive Crowns Sample Evaluation Satisfaction Esthetic Total Negative Positive
time partial fracture assessment assessment
fracture
Roberts et al To ascertain the Whiter Biter II 35 crowns Mean of 8.9 points 3 (8%) 9 (24%) Appearance Size and shape
2000 clinical success and (now known as 12 patients 20.7 months sout of 10 and color
parental acceptance of Dura Crowns) for
esthetic crowns anterior teeth
Shah et al Evaluar el xito Kinder Krowns 46 crowns Mean of 21 points out of 5 (11%) 6 (13%): Appearance Size and shape
2004 clnico y la satisfaccin for anterior teeth 12 parents-children 17.3 months a possible 25 4ICS,1ILS, (esthetic fracture,
de los padres de las From 2 to 6 1CS color and wear)
coronas estticas crowns/ patient
Champagne Evaluar la satisfaccin NuSmile for 238 crowns Minimum 6 93% (50 parents 27 (11%) 6 (< 1%) Visibility of Size and shape
et al 2007 de los padres de las anterior teeth 54 parents-children months out of a) metal and
coronas estticas 1crown/patient (Mean of 13 m) possible 54 durability
minimum
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Vol. 18. N. 3, 2010 DEVELOPMENT OF CROWNS AS RESTORATION MATERIAL FOR PRIMARY TEETH. A REVIEW OF THE LITERATURE 199
The parents gave scores for the crowns of 8.9/10 and chewing force of a child aged 5-10 years which is 375 N
8.4/10 respectively in the studies by Roberts et al. (4) (1,7).
and Shah et al. (6). For NuSmile general satisfaction Moreover, other factors that can lead to failure of
was slightly higher reaching 93% of the sample. esthetic facing such as overjet should be taken into
In general, the variables that showed differences that account. Children with increased overjet (> 6 mm) can
were more significant regarding satisfaction were (10): easily experience trauma and, as a result, there is a
Gender of the child. greater probability of failure at the resin-metal interface.
Future treatment options. However, increased overbite is not closely associated
The satisfaction perceived by the child. with increased wear values of esthetic facing (4,6).
The parents were less satisfied if the patient was Therefore, occlusion is a factor to be kept in mind when
male, and the mothers were far more critical that the making a prognosis as to the success of the treatment.
fathers. It was also observed that the satisfaction of the Studies such as Baker et al. (34) evaluated the force
parents was directly proportional to the satisfaction dis- necessary for fracturing, dislocating or deforming the
played by the children (10). veneers of preformed crowns with esthetic facing of the
Moreover, one of the greatest disadvantages of pre- different commercially available brands. From their
formed crowns with esthetic facing is the risk of frac- results it can be seen that the most resistant are those by
ture resulting in a poor esthetic appearance. Therefore, Cheng Crowns. Others such as NuSmile and Kinder
the manufacturers decided to limit the crimping of these Krowns, suffered partial/total fractures of the esthetic
crowns. Due to the controversy on whether to crimp or facing, and this result was attributed to the different
not, studies such as the one by Gupta et al. (7) appeared materials used by the manufacturers.
which compared the fracture-resistance of groups of The repair processes studied are easy and quick to
crimped and non-crimped esthetic facings. Although the apply. In addition the dentist does not need to remove the
crimped crowns had a greater tendency to resin loss crown and place another in order to repair it (34), but it
there was less of a fracture distribution interval, while should be kept in mind that repair materials offer less
the non-crimped group had very varied results. It should resistance than the original esthetic facing (32) (Table III).
be pointed out that the esthetic facing became separated Yilmaz et al. (44) obtained similar results. They eval-
from the metal resin interface, but it never became com- uated the adhesion force of an original esthetic facing
pletely unstuck. material and two different repair materials. They
The fracturing of esthetic facing is probably caused observed that the adhesion force of the original material
by trauma forces and not to incisal bite force. The force (870.6 N) was slightly higher than the force of the two
needed to fracture esthetic facing is 510.11N for non- repair materials (834.3 N for group 1 and 763.2 N for
contoured crowns and 511.02 N for contoured crowns. group 2), but there were no significant differences
In any event, this is considerably above the average between these two groups.
TABLE III
STUDIES THAT ASCERTAIN THE RESISTANCE IN VITRO TO FRACTURE OF PREFORMED CROWNS WITH ESTHETIC
FACING FOR THE ANTERIOR AND POSTERIOR REGIONS
Author year Objetive Crowns/Sample Brands Cycles Machine Speed Fracture force Fracture type
Baker et al To ascertain the resistance Anterior crowns of Cheng Crowns, Soaked in water for Mechanical machine 0.05 in/min Cheng Crowns Fractured, dislodged
1996 to fracture of 4 brands upper central incisors Kinder Krowns, 90 days, thermocycled tested (Instron, = 107.8 pounds deformed
of esthetic crowns N = 40 Whiter Bitter II, between 4 and 55 C, Canton, MA, NuSmile =
NuSmile for 500 45" cycles EE.UU.) with a 100.2 pounds
0.5 mm thickness Kinder Krowns
and a 9mm height = 91.3 pounds
and at an angle Whiter Biter II
of 148 = 81.5 pounds
Yilmaz y To ascertain the force Anterior crowns of NuSmile In water for a year, Mechanical test 0.05 inches/min 385 N* Not specified
Yilmaz needed to dislodge the upper central incisors. and once repaired at (Hounsfield, Raydon,
2004 esthetic facing N =16 4-55 C, 250 cycles, England) 0.5 mm
20"cycle thickness, and 8 mm
width, at an angle
of 148
Yilmaz et al To ascertain the bonding Posterior crowns of NuSmile In humid surroundings No especifica 1,5 mm/min 870.6N* Mastication force of
2008 strength of esthetic primary maxillary and at 37 C for 30 days, children = 375 N*.
facing and 2 repair mandibular molars thermocycled between
materials N = 22 4-55 C, 500 cycles
*1 Newton is equal to 0.225 pounds.
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