Stainless Steel Crowns (SSCs) are common, highly effective treatments in pediatric dentistry. These silver-colored restorations are pre-fabricated metal caps used to restore a primary, or baby, tooth that has been severely compromised. While their metallic appearance is visually distinct, SSCs are a durable and long-lasting solution that protects the underlying tooth structure. They have a high success rate and are a reliable way to maintain the function of a damaged primary tooth until it is naturally shed.
Understanding Stainless Steel Crowns
A stainless steel crown is a full-coverage restoration made from a combination of metals, primarily iron, chromium, and nickel. This composition makes the crown highly durable and resistant to the corrosive environment of the mouth, including saliva and chewing forces. SSCs are pre-formed shells that come in a variety of sizes and shapes, unlike custom-fabricated crowns for permanent teeth. The pediatric dentist selects the best-fitting shell, which simplifies the placement process.
The primary function of the crown is to encase and protect the entire clinical crown of the damaged tooth. This complete coverage prevents bacteria from re-entering the tooth, effectively halting the progression of decay. Because of their strength, stainless steel crowns are typically utilized on the posterior teeth, specifically the primary molars, where chewing forces are greatest and aesthetics are less of a concern.
When Dentists Recommend Silver Crowns
Dentists recommend stainless steel crowns when a traditional filling would not provide adequate long-term protection for a primary tooth. The most frequent indication is when decay is extensive, affecting three or more surfaces of the tooth, or when the cavity is simply too large for a standard restoration. A large filling may weaken the remaining tooth structure, making it susceptible to fracture under normal chewing pressure, which the full coverage of an SSC prevents.
SSCs are also indicated following a pulpotomy, which is a procedure where the infected nerve tissue in the crown of the tooth is removed. After this procedure, the tooth is structurally weakened and must be sealed and protected to prevent bacterial contamination, making the SSC the restoration of choice. Additionally, children who are categorized as having a high risk of developing new cavities often benefit from SSCs, even for smaller lesions, because of the crown’s ability to seal the tooth and prevent new decay effectively.
Furthermore, children with certain developmental defects of the tooth enamel, such as amelogenesis imperfecta or enamel hypoplasia, require the full, uniform protection an SSC offers. These conditions result in poorly formed, weak, or highly sensitive enamel that is prone to rapid wear and decay. For young patients who may have difficulty cooperating for complex procedures, SSCs can be placed efficiently, sometimes under sedation or general anesthesia, providing a predictable, single-visit solution.
How the Crown Stays and When It Comes Off
Placing the stainless steel crown involves minimal preparation of the tooth to ensure the shell can be seated correctly. After the decay is removed and the tooth is contoured, the dentist selects the appropriately sized crown, crimps the edges for a tight fit, and then cements it permanently onto the tooth. The crown is secured using a strong, biocompatible dental cement which creates a tight seal against the tooth structure. Once cemented, the crown covers the tooth from the biting surface all the way to the gum line, providing mechanical retention and a barrier against the oral environment.
The crown is intended to remain in place for the entire functional lifespan of the primary tooth, which can be several years. Primary teeth are naturally shed through a process called root resorption, which is initiated by the erupting permanent tooth below them. As the permanent tooth pushes upward, it causes the roots of the baby tooth to dissolve. The SSC does not interfere with this biological process, as the crown is only cemented to the crown of the baby tooth, not the roots.
When the root of the baby tooth has completely resorbed, the primary tooth becomes loose and naturally falls out, taking the stainless steel crown with it. The crown and the remainder of the baby tooth structure are shed as a single unit. In rare instances, the crown may become loose and come off prematurely due to sticky foods or a failure of the cement, in which case the dentist will need to re-cement it or place a new crown to continue protecting the tooth.