STAINLESS STEEL CROWN
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Definition
PREFABRICATED CROWN FORMS THAT ARE ADAPTED TO INDIVIDUAL TEETH AND CEMENT WITH A BIOCOMPATIBLE LUTING AGENT
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Composition
- SSC CROWNS – AUSTENITIC STAINLESS STEEL
- NICKEL CHROMIUM CROWN - NICKEL CHROME IRON)
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CLASSIFICATION OF SSC
- UNTRIMMED CROWNS
- PRETRIMMED CROWNS
- PRECONTOURED CROWNS
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Indikasi
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Karies yang meluas
over 30% of large fillings placed on primary teeth fail
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Dekalsifikasi yang meluas
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Karies rampan
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Karies yang berulang
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Gigi Post PSA
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Defek Enamel (Hypoplasia, amelogenesis imperfecta)
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Bruxism yang parah
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Gigi yang dijadikan sebagai abutmen pada pembuatan protesa
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Sebagai bagian dari space maintainer
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Kontraindikasi
- Molar sulung yang sudah dekar waktu exfoliasinya
- Molar sulung yang akarnya sudah teresorbsi >1/2
- Gigi goyang
- Periodontal problem
- TEETH THAT EXHIBIT MOBILITY
- TEETH WHICH ARE NOT RESTORABLE
- PATIENTS WITHH KNOWN NICKEL ALLERGY
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ARMAMENTARIUM/ Peralatan
- CROWN CUTTING BUR
- PLIERS (Tang)
- SCALER OR ANY SHARP INSTRUMENT
- CROWN & BRIDGE SCISSORS
- CROWN SEATER & REMOVER
- STONE & FINISHING BURS FOR CROWN FINISHING
- FOR CEMENTATION
- MISCELLANEOUS : ARTICULATING PAPER, WAX SHEET, GLASS MARKING PENCIL
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EVALUATION OF PREOPERATIVE OCCLUSION
Relasi oklusi apakah bisa dipasang SSC (X tll pendek)
- THE OBJECTIVE IS TO REPLICATE THE EXISTING OCCLUSION AFTER THE SS CROWN PLACEMENT
- DENTAL MIDLINE AND CUSP-FOSSARELATIONSHIPS BILATERALLY MUST BE ASSESSED
- BEFORE STARTING THE TOOTH PREPARATION WE SHOULD EVALUATE THE OCCLUSION BY VISUAL EXAMINATION & TRANSFER THIS RELATION ON TO THE WAX SHEET BY ASKING THE PATIENT TO BITE ON IT
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Jenis SSC
- Direct→ vital
- Indirect
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Pengurangan Oklusal
- START WITH PEAR SHAPE BUR
- Pengurangan oklusal 1 -1,5 mm ALONG THE CUSPAL STRUCTURE
- THE REDUCTION IS DETERMINED BY COMPARING THE MARGINAL RIDGES OF ADJACENT TEETH
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Pengurangan Proximal
- dengan long thin
- jangan merusak gigi tetangga (lindung dg band)
THE PROXIMAL REDUCTION IS DONE WITH THE HELP OF TAPERING FISSURE & NEEDLE BURS WITH THE MAIN OBJECTIVE OF BREAKING THE CONTACT SLICE THE MESIAL & DISTAL SURFACES WITH NEEDLE BUR & BREAK THE CONTACT BETWEEN THE TEETH WITH TAPERING FISSURE BUR.
AVOID BUR DAMAGE OR MARKS ON ADJACENT TEETH
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BUCCAL/LINGUAL REDUCTION
- tidak wajib dikurangi karena untuk retensi, klo bisamasuk yaudah gausah dikurangi
- BUCCOLINGUAL REDUCTION FOR THE SSC PREPARATION IS OFTEN LIMITED TO THIS BEVELING & IS CONFINED TO THE OCCLUSAL ONE THIRD OF THE CROWN
- IF PROBLEMS ARE LATER ENCOUNTERED IN SELECTING AN APPROPRIATE CROWN SIZE OR IN FITTING A CROWN OVER A LARGE MESIOBUCCAL BULGE, MORE REDUCTION OF THE BUCCAL AND LINGUAL TOOTH STRUCTURE MAY BECOME NECESSARY
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FINISHING
- permukaan yang tajam dihaluskan
- REDUCE AND ROUND OFF ALL LINE ANGLES & SHARP CORNERS OF THE PREPARATION WITH THE HELP OF FINISHING BURS
- THE OCCLUSAL AS WELL AS THE PROXIMAL ASPECT MUST BE ROUNDED OF BUT WITH UTMOST CARE SO AS TO AVOID ANY FURTHER REDUCTION
- VERIFY THE OCCLUSION & PROXIMAL CONTACTS. THERE SHOULD BE A GAP OF 1 -1,5mm BETWEEN THE PREPARED TOOTH & THE OPPOSING TOOTH DURING OCCLUSION
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The 6 Stages of Crown Placement
SIZE
FILL
LOCATE AND SEAT
WIPE
SEAT FURTHER
CLEAN
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CROWN SELECTION (1)
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Direst SSC
- Mengukur gigi langsung di rongga mulut dengan venire calipers (jangka sorong), boley wire (kawat lunak), probe
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Indirect SCC
- Preparasi
- Cetak gigi
- Pemilihan mahkota dicocokkan di cetak gigi
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misc
- ADEQUATE MESIODISTAL DIAMETER, LIGHT RESISTANCE TO SEATING, AND PROPER OCCLUSAL HEIGHT
- THE GOAL IS TO SELECT THE SMALL CROWN THAT COMPLETELY COVERS THE PREPARATION & ESTABLISH PROPER PROXIMAL CONTACTS
ANY OF THE FOLLOWING THRE DIFFERENT METHODS CAN BE USED FOR CROWN SELECTION WITH PREDICTABLE SUCCESS:
- TRIAL & ERROR METHOD BY ARBITRARILY SELECTING DIFFERENT SIZES
- MEASURING THE INTERNAL MESIODISTAL MEASUREMENT BY USING A BOLEY GAUGE OR VENIRE CALIPERS
- BY USING CHARTS
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CROWN ADAPTATION
- 1 box isi banyak ada yg besar/kecil
- pilih yg lebih kecil (kebesaran→ kebocoran tepi)
- potong servikal SSC klo blum pas pakai gunting atau mata bur dihaluskan pakai spoon, finishing bur
- cek relasi oklusi harus seperti sebelum dipasang (apakah garis median sebelum dipasang lurus)
- jaringan ginggiva sekitar
- tekuk bagian servikal (crimping) biar nutup
- misc
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COUNTOURING
- Contour the crown with ball and socket plier *buccal and lingual)
- CONTOUR THE CROWN WITH PLIERS
A BALL AND SOCKET PLIERS IS USED TO CONTOUR THE BUCCAL & LINGUAL SURFACES
THE ADVANTAGE OF COUNTOURING IS THAT THE CROWN GETS WORK HARDENED BY MANIPULATION & BECOMES MORE RETENTIVE
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CRIMPING OF THE CROWN (tekuk)
- mencegah kebocoran semen pake tang crimping
USING THE CRIMPING PLIERS THE CROWN IS CRIMPED IN THE GINGIVAL THIRD
THE USES OF CRIMPING ARE PROTECTION OF SOFT TISSUES, PREVENTION OF LEAKAGE OF CEMENTS, PREVENTION OF CONTAMINATION AND ADEQUATE RETENTION
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CHECKING THE FINAL FIT
CHECK ALL THE MARGINS FOR ADAPTION
SEAT THE CROWN IN A LINGUAL TO BUCCAL DIRECTION
EVALUATE OCCLUSAL HARMONY & COMPARE IT WITH PREOPERATIVE OCCLUSION
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CROWN FINISHING
- dihaluskan dengan stone/ rubber wheel
- THE FINISHING OF THE MARGINS OF THE CROWN FORM IS DONE USING A GREEN STONE
- USE A SLOW SPEED HANDPIECE
- CROWN IS THEN SMOOTHENED WITH FINISHING BURS & POLISHED WITH RUBBER WHEEL OR ROUGE
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CROWN CEMENTATION
- pakai GIC tipe 1, zinc phosphat cement, ZOE, polyxarboxylate,
- arah pasang (sementasi) dari lingual ke bukal
- dibersuhkan pakai cotton pelet, brush, pumais
- mis
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POLISHING OF SSC
- pakai fosfat fluoride prophylaxys paste
POLISH THE CROWN WITH ACIDULATED PHOSPHATE FLUORIDE PROPHYLAXYS PASTE PRIOR TO DISCHARGING THE PATIENT
AFTER THE CEMENT SETS IT ADVISEABLE TO TO MOVE A WAXED FLOSS IN THE INTER-PROXIMAL ASPECT TO CHECK FOR ANY EXCESS CEMENTAS IT MAY CAUSE IRRITATION & INFLAMMATION OF TISSUES
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selama 30 menit jangan makan, jgn dibuat mainan (ungkit2)
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