|Year : 2015 | Volume
| Issue : 1 | Page : 49-51
A novel technique to check the occlusion during the placement of stainless steel crowns under general anesthesia
Mohiddin Dimashkieh1, Sharat Chandra Pani2
1 Department of Prosthodontics , Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
2 Department of Preventive Dental Sciences, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
|Date of Web Publication||2-Feb-2015|
Sharat Chandra Pani
Department of Preventive Dental Sciences, Riyadh Colleges of Dentistry and Pharmacy, P. O. Box 84891, Riyadh 11681
Source of Support: None, Conflict of Interest: None
Stainless steel crowns are the restoration of choice for the treatment of badly decayed posterior teeth under general anesthesia. The evaluation of occlusion after the placement of these crowns, however, remains a difficult task. This paper outlines a technique to evaluate the occlusion of stainless steel crowns placed under general anesthesia using a specially designed tray and a fast setting polyvinyl siloxane bite registration material (Regisil® PB™, Dentsply, Surrey UK).
Keywords: General anesthesia, occlusion, stainless steel crowns
|How to cite this article:|
Dimashkieh M, Pani SC. A novel technique to check the occlusion during the placement of stainless steel crowns under general anesthesia. Saudi J Oral Sci 2015;2:49-51
|How to cite this URL:|
Dimashkieh M, Pani SC. A novel technique to check the occlusion during the placement of stainless steel crowns under general anesthesia. Saudi J Oral Sci [serial online] 2015 [cited 2020 Jan 26];2:49-51. Available from: http://www.saudijos.org/text.asp?2015/2/1/49/150599
| Introduction|| |
Stainless steel crowns are arguably the most successful posterior restorations in primary teeth and have been so for more than 50 years.  Stainless steel crowns offer durability and success rates in excess of 95% making them the restoration of choice for posterior primary teeth in children treated under general anesthesia. ,,,
It is generally accepted that the occlusion for stainless steel crowns is checked clinically with the dentist adjusting the bite.  However, this becomes extremely difficult under general anesthesia where closing the child's mouth is both difficult and time-consuming. Furthermore, there is recent evidence to show that a significant number of stainless steel crowns placed without proper clinical adjustment of the bite by the dentist result in a temporary increase in a vertical dimension. 
The aim of this paper was to describe a technique to check the occlusion of the patient under general anesthesia and evaluate the occlusion, time taken for placement and the overall success of bilateral multiple stainless crowns placed using this technique under general anesthesia.
| Materials and Methods|| |
Preparation of the tray
A special tray is prepared but sectioning a small sized plastic lower tray in half and cutting away the buccal flange [Figure 1]. Alternatively, the buccal flange can be cut away from a sectional tray. This tray facilitates the carrying of the bite registration material into the patient's mouth and allows for accurate placement of the material in a patient who is devoid of any voluntary or involuntary control of muscle tone. The tray is disposed after single use, however to comply with operating room disinfection protocol, the trays are sterilized using chemical sterilization.
Making the impression
Impressions are made separately for each quadrant, using a fast setting polyvinyl siloxane bite registration material (Regisil#894; PB™, Dentsply, Surrey UK). The material is then cut away from the buccal flange so as to provide the operator with a template that will enable the dentist to visualize the buccal and part of the occlusal surface of the crown to assess the occlusal fit of the crown [Figure 2].
|Figure 2: Prepared template after cutting away the buccal and part of the occlusal portions of the impression|
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Using the template
Teeth needing crowns in a quadrant are prepared (with or without pulp therapy) using the accepted procedure for the placement of stainless steel crowns. The template is first used as a guide to ensure that the teeth are not over-reduced. The crowns are placed on the prepared teeth, and the template is placed on the crown to detect occlusal discrepancies [Figure 3] and once these are corrected the template is used again to confirm the correct occlusion.
| Discussion|| |
The role of occlusion following the placement of stainless steel crowns under general anesthesia is often overlooked. Most authors either fail to address the issue or state that growth of the jaws and eruption of the teeth would overcome any problems in occlusion caused by the placement of high stainless steel crowns. ,,, It is only recently that the issue of occlusion and occlusal load following the placement of stainless steel crowns has received attention in the literature. ,
This technique looks at a method that could help dentists identify occlusal discrepancies under general anesthesia; the impression serves as a template for the evaluation of occlusion. It has been observed by van der Zee et al. that high points in occlusion are often compensated for by growth of the jaws, with a return to normal equilibrium in the vertical dimension within 3 months. 
Gallagher et al., using a bite analysis system, have shown that checking the occlusion by clinically evaluating the bite on the chairside is sufficient to restore the preoperative maximum intercuspation position within 4 weeks.  It is this clinical evaluation of the bite; not available to the dentist working under general anesthesia; that this technique seeks to provide.
| Conclusion|| |
It is hoped that the above-described method of checking the occlusion will provide dentists with a useful tool to evaluate the occlusion while placing stainless steel crowns under general anesthesia. However, detailed studies with adequate controls are needed to evaluate the overall benefits of using this technique.
| References|| |
Attari N, Roberts JF. Restoration of primary teeth with crowns: A systematic review of the literature. Eur Arch Paediatr Dent 2006;7:58-62.
Al-Eheideb AA, Herman NG. Outcomes of dental procedures performed on children under general anesthesia. J Clin Pediatr Dent 2003;27:181-3.
Eshghi A, Samani MJ, Najafi NF, Hajiahmadi M. Evaluation of efficacy of restorative dental treatment provided under general anesthesia at hospitalized pediatric dental patients of Isfahan. Dent Res J (Isfahan) 2012;9:478-82.
Vinckier F, Gizani S, Declerck D. Comprehensive dental care for children with rampant caries under general anaesthesia. Int J Paediatr Dent 2001;11:25-32.
Seale NS. The use of stainless steel crowns. Pediatr Dent 2002;24:501-5.
van der Zee V, van Amerongen WE. Short communication: Influence of preformed metal crowns (Hall technique) on the occlusal vertical dimension in the primary dentition. Eur Arch Paediatr Dent 2010;11:225-7.
Drummond BK, Davidson LE, Williams SM, Moffat SM, Ayers KM. Outcomes two, three and four years after comprehensive care under general anaesthesia. N Z Dent J 2004;100:32-7.
Ibricevic H, Al-Jame Q, Honkala S. Pediatric dental procedures under general anesthesia at the Amiri Hospital in Kuwait. J Clin Pediatr Dent 2001;25:337-42.
Gallagher S, O'Connell BC, O'Connell AC. Assessment of occlusion after placement of stainless steel crowns in children - A pilot study. J Oral Rehabil 2014;41:730-6.
[Figure 1], [Figure 2], [Figure 3]