Indications for Kids Crowns

• Restorations for primary and young permanent teeth with extensive or multiple carious lesions
• Restorations for primary and young permanent teeth with hypoplasia
• Restorations for teeth with developmental anomalies
• Restorations for primary and young permanent teeth that have undergone pulpotomy or pulpectomy
• Restorations for teeth with fractures
• As an interim measure for permanent molars, where crowns are required but the patient is too young
• Restorations for primary teeth that serve as abutments for space maintainers, orthodontic appliances and habit breaking appliances

Conventional technique for placement of Kids Crowns

Kids Crowns rely for retention only on a tight adaptation at the gingival margin of the preparation, therefore taper of preparation walls is not critical. The following is the description of the clinical steps to place Kids Crowns:

• Administer local anaesthesia and apply rubber dam, if possible.
• Measure mesio-distal length of tooth to be crowned with dividers to aid in crown selection.
• Remove caries.
• Occlusal reduction (approximately 1mm), roughly following cuspal planes.
• Proximal reduction (around 20° from vertical) using tapered diamond, without producing a ledge at gingival margin.
• Remove buccal and lingual prominences only sufficient to seat crown (often little/no reduction required).
• Select the crown. Correct size will be a ‘click’ fit.
• Check height and occlusion. Minor prematurity is not a problem. If extensive blanching of surrounding tissues is seen or if the crown seems over-extended, trim the crown. Usually this may not be necessary.
• Use pliers to adapt contact points and crimp margins. Smooth trimmed margins with stone.
• Cement with zinc polycarboxylate or glass ionomer cement.
• Technique for permanent molars is similar but more careful adjustment is necessary

Hall’s technique for placement of Kids Crowns

In this relatively new technique, no conventional preparation or caries removal is normally carried out. After simply removing any loose debris, a crown is cemented over the carious, unprepared molar. Local anaesthesia is not usually required, with the child ‘biting’ the cement-filled crown down into place. Advocates of the technique suggest its use is restricted to asymptomatic teeth with no evidence of pulpal inflammation/necrosis/periodontal involvement

• Separators placed a few days before may aid placement.
• Check that the carious deciduous molar is free from obvious pulpal or periradicular pathology.
• Select correct-size crown, fill with a suitable cement (Glass ionomer cement is recommended) and place on tooth.
• Get child to bite down on crown, seating it onto the tooth.
• Clear away excess cement
• Crown is likely to be in premature occlusion, but as long as this is not gross, occlusion usually evens out by dento-alveolar compensation within a few weeks.
• Initial studies of ‘Hall’ technique for placing Kids Crowns have also indicated very favourable results probably due to creation of an effective pericoronal seal.