An evaluation of the effect of stainless steel crowns, placed in pediatric patients in the operating room, on the gingival health
Hasan, Mohammad A.
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Stainless steel crowns, also referred to as preformed metal crowns, have been used widely in pediatric dentistry for restoring primary teeth, especially primary molars. They are considered superior to any other restorative materials and are the most durable restoration in pediatric patients. High caries risk children exhibiting multiple caries should be treated with stainless steel crowns to protect the remaining high risk tooth surfaces. The majority of the previous studies indicated an association between placement of stainless steel crowns and gingival irritation due to crown defects or errors in marginal adaptation. The most common errors are those in crimping, contouring, and crown length. Treatment under general anesthesia has been proven to result in the best treatment outcomes compared to other clinical settings. In order to reduce potential defects and errors in crown preparation and placement, and to minimize patient behavior challenges, treatment under general anesthesia was used. The purpose of this study was to evaluate the effect of stainless steel crowns placed on primary teeth of pediatric patients who present to the operating room for treatment, relative to their gingival health, plaque accumulation, and presence of inflammation. The materials and methods used for this study were to examine a total of eighty (80) healthy children, male and female between the ages of 3 -9. Subjects were assigned into two groups of 40 subjects per group. Group A (experimental group) included 40 healthy subjects in need of Stainless Steel Crowns on their primary molars. Group B (control group) included 40 healthy subjects that do not have Stainless Steel Crowns on their Primary molars and are caries-free. All children enrolled were patients of the Dental service at Women and Children's Hospital of Buffalo. To ensure standardization and decrease variability in this study, only stainless steel crowns that were placed by the same dentist were examined. Informed consent was obtained from the patient's legal guardian prior to the start of the research study. All examinations included a review of the medical history and an evaluation of gingival health, consisting of a Modified Gingival Index and a Modified Turesky Plaque Index. Each subject was examined twice for gingival health based on plaque accumulation and presence of inflammation. The first examination occurred at baseline and the second examination at the follow-up appointment. Only the primary investigator performed all baseline and follow-up examinations to ensure uniformity in scoring. The results were analyzed by making a statistical comparison between the two groups at baseline appointment, follow-up appointment, and the difference between these two appointments for each index using the Wilcoxon rank-sum test. In addition, the changes in plaque index and gingival index from baseline to the follow-up within the same group were evaluated using the paired t-test. Gingival health was evaluated based on measuring the gingival index and plaque index between the two groups at anytime, and on measuring the differences of these indices among each group from baseline to follow-up. The results of this study demonstrated that there was no correlation between placement of the stainless steel crowns and plaque accumulation around stainless steel crowns. However, there was positive correlation between placement of the stainless steel crowns and the presence of inflammation around the stainless steel crowns. These findings lead to the conclusion that the higher prevalence of the gingivitis around the stainless steel crowns was due to the presence of the stainless steel crowns and was not caused primarily by supragingival plaque accumulation. Despite the effort made to increase the success rate and reduce variability in the stainless steel crowns that were examined, such as the use of a single operator with very good experience to restore the teeth, the use of general anesthesia in the operating room as a behavior management tool, and the 2-week follow up appointment after the GA appointment, there were still gingival changes present around the stainless steel crowns at the 3 months follow up appointment.