Full Coverage Aesthetic Restoration of Posterior Primary Teeth
Open-faced Stainless Steel Crowns

Advantages

• The aesthetics are good but not great (the metal shows through the composite facing).
• They are very durable, wear well and retentive.
• The materials are fairly inexpensive.

Disadvantages

• The time for placement is long as it involves a two-step process (crown cementation/composite facing placement.
• Placement of the composite facing may be compromised when gingival hemorrhage or moisture is present, or when the patient exhibits less than ideal cooperation.

Technique

• Once the cement in the stainless steel crown is set, cut a labial window in the cemented crown using a no. 330 or no. 577 bur.

• Extend the window:
• Just short of the occlusal edge.
• Gingivally to the height of the gingival crest.
• Mesio-distally to the line angles.

• Remove the cement to a depth of 1 mm.
• Place undercuts at each margin with a no. 35 bur or with a no. ½ round bur.
• Smooth the cut margins of the crown with a fine green stone or white finishing stone.

• After using a glass ionomer liner to mask differences in color between remaining tooth structure and cement, place a layer of bonding agent.
• Place resin based composite into the cut window forcing the material into the undercuts and polymerize.
• Add additional material in 1 mm increments and polymerize.

• Finish the restoration with abrasive disks.
• Run the disks from the resin to the metal at the margins so as not to discolor the resin with metal particles.

While more aesthetic than a conventional stainless steel crown, a shortcoming of an open-faced, stainless steel crown is the bleeding of the metal color from the lingual and interproximal surfaces through the composite resulting in a grayish tinge to the facing.⁷