Stainless Steel Crowns (SSCs), often called “silver caps,” are traditionally used in pediatric dentistry to restore heavily decayed or fractured baby teeth. Adults often wonder if this durable, quickly placed option is available to them. While SSCs are not the standard treatment for permanent adult teeth, they do have specific, limited applications in adult restorative care.
What Stainless Steel Crowns Are
A Stainless Steel Crown (SSC) is a pre-formed metal shell designed to cap and protect a damaged tooth. They are typically composed of an alloy of iron, chromium, and nickel, which provides excellent strength and corrosion resistance. Unlike custom-made crowns, SSCs come in pre-sized options that a dentist adapts and cements onto the tooth.
The primary role of the SSC is in pediatric dentistry, where they restore primary molars with extensive decay or after pulp therapy. SSCs are highly effective for children because they offer complete coverage in a single, quick appointment. Since the primary tooth is temporary, the SSC only needs to last until the tooth naturally falls out.
Specific Indications for Adult Use
Stainless steel crowns can be used on permanent adult teeth, but only under select circumstances that prioritize speed and durability over aesthetics and custom fit. One common application is as a long-term interim restoration for a tooth requiring complex, multi-stage treatment. For instance, a dentist might place an SSC to protect a tooth after a root canal while waiting for healing or planning a final, custom crown.
SSCs are also beneficial for medically compromised or elderly patients who cannot tolerate lengthy or multiple dental procedures. They require minimal chairside time and tooth reduction compared to custom crowns, making them a less taxing option. Their cost-effectiveness also makes them a choice when financial constraints are a factor, particularly for non-visible back teeth.
In emergency or public health dentistry, SSCs offer immediate, robust protection for a severely damaged permanent molar. They prevent further tooth breakdown and maintain chewing function until a patient can receive definitive care. For permanent molars that are partially erupted or have an unstable bite, an SSC can serve as a transitional restoration that stabilizes the tooth structure.
Reasons They Are Not Standard Adult Treatment
Stainless steel crowns are generally not the standard choice for routine adult crown placement because they lack the precision and aesthetic qualities of custom restorations. The most obvious drawback is their metallic, silver appearance, which is typically unacceptable for visible teeth. This aesthetic limitation restricts their use almost entirely to non-visible back molars.
Beyond appearance, SSCs are pre-formed and adapted, meaning they do not achieve the precise marginal seal of a laboratory-made crown. Over the decades an adult crown is expected to last, this less-than-perfect fit can increase the risk of microleakage. This potentially allows bacteria to seep under the crown and cause recurrent decay. Furthermore, while durable, the occlusal surface of some SSCs may be prone to wear or perforation over many years of heavy adult chewing forces.
Preferred Adult Crown Materials
The standard materials used for permanent adult crowns offer superior customization, fit, and aesthetic integration compared to stainless steel. Porcelain-Fused-to-Metal (PFM) crowns provide a balance of durability and natural appearance, using a metal substructure covered by tooth-colored porcelain. PFM crowns are a reliable option, though a visible gray line may sometimes appear at the gum margin.
All-ceramic crowns, such as those made from Zirconia or Lithium Disilicate (Emax), are increasingly common, especially for visible teeth. Zirconia is an extremely strong ceramic often used for back molars due to its high resistance to fracture and wear. Lithium Disilicate is favored for its excellent translucency, closely mimicking the look of natural tooth enamel.
Full metal crowns, often made from gold or other metal alloys, remain an option for back teeth requiring maximum durability. These crowns require the least amount of natural tooth structure removal and are highly resistant to wear. This makes them a long-lasting choice for patients who grind their teeth. The choice of material depends on the tooth’s location, bite forces, and aesthetic priorities.