|Year : 2018 | Volume
| Issue : 3 | Page : 273-278
Gingival, oral hygiene and periodontal status of the teeth restored with stainless steel crown: A prospective study
Shashikala Prabhu1, SH Krishnamoorthy2, Savitha Sathyaprasad2, H Sharath Chandra3, J Divyia4, Aiswarya Mohan5
1 Paedodontist and Preventive Dentist, Manipal, Karnataka, India
2 Department of Paedodontics and Preventive Dentistry, KVG Dental College, Sullia, Karnataka, India
3 Department of Paedodontics and Preventive Dentistry, SJM Dental College, Chitradurga, Karnataka, India
4 Paedodontist and Preventive Dentist, Pettah, Trivendrum, Kerala, India
5 Dentist, Kings Dental Centre, Qatar
|Date of Web Publication||24-Sep-2018|
Dr. Shashikala Prabhu
4-610, Alevoor Road, Manchikere, Manipal, Karnataka - 576107
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: To compare the gingival health and periodontal status in primary molars restored with stainless steel crowns with unrestored contralateral teeth. Materials and Methods: A split mouth design study was conducted on 60 children aged 5- 10 years who required stainless steel crown restoration on deciduous molars. The molar teeth restored with stainless steel crown were selected for study and healthy unrestored contralateral teeth were selected as controls. Bitewing radiograph of study and control tooth was taken at initial, three months and at six months. The gingival status, oral hygiene status was evaluated at three months and six month intervals using gingival index and oral hygiene index respectively. Result: On evaluating the oral hygiene status at three months study group showed the mean value of 0.7±0.700 whereas in control group it was 1±0.368. At six months it was 1.183±0.390 in study group and 1.5±0.504 in control group. Chi square test shows that the crown marginal adaptation produced statistically significant difference at six months. Crown marginal extension did not produce any difference on gingival index and oral hygiene index. Conclusion: When compared to control teeth, the teeth restored with stainless steel crown showed lesser plaque and debris accumulation at three months and six months. Radiographic bone level the control teeth showed higher level of bone resorption compared to the teeth restored with stainless steel crown.
Keywords: Oral hygiene, radiographic bone level, stainless steel crown
|How to cite this article:|
Prabhu S, Krishnamoorthy S H, Sathyaprasad S, Chandra H S, Divyia J, Mohan A. Gingival, oral hygiene and periodontal status of the teeth restored with stainless steel crown: A prospective study. J Indian Soc Pedod Prev Dent 2018;36:273-8
|How to cite this URL:|
Prabhu S, Krishnamoorthy S H, Sathyaprasad S, Chandra H S, Divyia J, Mohan A. Gingival, oral hygiene and periodontal status of the teeth restored with stainless steel crown: A prospective study. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2021 Mar 2];36:273-8. Available from: https://www.jisppd.com/text.asp?2018/36/3/273/241968
| Introduction|| |
Dental caries is the most prevalent disease, especially in children. The importance of primary teeth should be considered in helping speech, mastication, maintaining arch length, and cosmetic function. Pediatric dentistry can play a vital role in the dental development of the young patient by providing natural space maintainers for the permanent teeth and by instilling positive attitude toward oral health in the child. As the treatment of primary and young permanent teeth with advanced carious lesion has been a constant and difficult problem for the dentist, the stainless steel crown (SSC) has become an important factor in the restoration of the extensively carious lesion.
SSCs provide durable and reliable full coverage restorations and are retained for the lifetime of a primary tooth. The SSC has been shown to be the restoration of choice, or the “gold standard,” because it protects the tooth from fracture, minimizes the possibility for leakage, and ensures a biological seal.
Traditional SSCs have many advantages over other crown types and dental restorative materials. First, their lifespan is the same as that of an intact primary tooth. Second, they provide protection to the residual tooth structure that may have been weakened after excessive caries removal. Third, the technique sensitivity or the risk of making errors during their application is low. Fourth, their long-term cost-effectiveness is good. Fifth, they have a low failure rate.
This study aims to compare the gingival health and periodontal status in primary molars restored with SSCs with unrestored contralateral teeth.
To assess the gingival and periodontal status of the teeth restored with SSC, to evaluate oral hygiene status of children with SSC, to evaluate radiographic changes in teeth restored with SSC, and to compare with contralateral control teeth.
| Methodology|| |
A split-mouth, parallel design, randomized controlled study was conducted on 60 children age group of 5–10 years visiting K.V.G Dental College and Hospital, Sullia, Dakshina Kannada, for treatment of molars indicated for restoration with SSC. Contralateral tooth of the same patient which not restored with SSC was taken as control. Consent for the participants willing to participate in the study was obtained.
Tooth preparation done and selected SSC was cemented on it after proper reduction, crimping and polishing. Radiograph of the tooth restored with SSC and contralateral tooth was taken on the day of cementation of the crown. The gingival index (GI) was measured for the study tooth and control tooth. Oral Hygiene Index (OHI) and radiographic bone health for the study tooth and control tooth was measured. The bitewing radiographs were placed on the X-ray viewer and the height of interdental bone was measured from the crest of the interdental bone to the cementoenamel junction (CEJ). Height of the interdental bone was measured for the study tooth and control tooth. Parameters affecting GI and interproximal bone level were measured.
Scoring criteria for OHI:
- 0 – No debris
- 1 – Soft-tissue debris covering <1/3rd of tooth surface
- 2 – Soft-tissue debris covering >1/3rd but <2/3rd of tooth surface
- 3 – Soft-tissue debris covering >2/3rd of tooth surface.
Scoring criteria for GI:
- 0 – Normal gingiva
- 2 – Presence of mild inflammation
- 3 – Moderate inflammation
- 4 – Severe inflammation.
Radiographic evaluation was done using bitewing radiograph. A standard angulation of X-ray cone was applied. The radiographs were selected on the basis of minimal evidence of distortion, minimal overlapping between the adjacent proximal surfaces, a clear image of the CEJ, and the alveolar bone crest (ABC) between the primary molars.
The radiographic criteria viewed were interproximal bone level 2 mm or less from the crest of the interdental bone and CEJ was considered normal or nonresorbed. If the distance was >2 mm, it was considered as resorbed. If the crown margins were too short or extended below the CEJ, it was considered as inadequate crown.
| Results|| |
This study included 60 children aged 5–10 years of with the mean age of 6.7 years. The mean OHIs score of SCC group at 3 months was found to be 0.700 ± 0.462 and in control group, it was found to be 1 ± 0.368 and there was a statistically significant difference between group at 5% significance level (P < 0.001). The mean OHIs score of SCC group at 6 months was found to be 1.183 ± 0.390 and in control group, it was found to be 1.500 ± 0.504 and there was a statistically significant difference between groups at 5% significance level (P < 0.001). The mean GI score of SCC group at 6 months was found to be 1.216 ± 0.415 and in control group, it was found to be 1 and there was a statistically significant difference between groups at 5% significance level (P < 0.001). The mean RBH at 3 months in SCC group was found to be 1.841 ± 0.251 and in control group, it was found to be 1.866 ± 0.222, and there was no statistically significant difference between group at 5% significance level (P = 0.566). The mean RBH at 6 months in SCC group was 1.975 ± 0.282 and in control group, it was 2.333 ± 0.438 and there was a statistically significant difference between group at 5% significance level (P < 0.001) [Table 1] and [Graph 1].
|Table 1: Paired sample statistics for the oral hygiene, gingival index and radiographic bone health|
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| Discussion|| |
This study showed the time-dependent comparison of primary molar teeth restored with SSC with the intact primary molars of the contralateral side at 3 months and 6 months of intervals. The oral hygiene, gingival status, and radiographic bone health of the study group and the control group were assessed at 3 months and 6 months of duration.
Studies found that good-to-moderate fitting crowns with well-contoured crown margins facilitate good oral hygiene, healthy gingiva, and minimal plaque accumulation. Plaque starts to accumulate when the margins of an SSC begin to degenerate. The fit into the residual undercuts help in the retention of the cemented crown (Savides et al., 1979). The purpose of crown trimming and contouring is to leave the crown margins in the gingival sulcus and to reproduce the morphology of tooth.
Gingivitis is the predominant form of periodontal disease in children and adolescents, and it consists of a nonspecific inflammation of the marginal gingiva. It has been reported that gingivitis often occurs around primary teeth restored with steel crowns due to diverse factors, mainly to improper techniques during all the therapeutic process. Waerhaug, however, reported that plaque can accumulate around crowns with well-adapted margins. He also proposed that the gingivitis around teeth that were restored with an SSC is dependent on the presence of bacterial plaque and not dependent on mechanical irritation due to the crown's presence.
In our study, the oral hygiene status of the study group (SSC) at 3 months was good with the mean of 0.7 ± 0.462 compared to the control healthy, uncrowned teeth which showed the mean value of 1 ± 0.368. At 6 months, the oral hygiene status of the SSC and control teeth increased. Despite the increase in the Simplified OHI-S score, the mean score of SSC teeth was less, that is, 1.183 ± 0.390 compare to healthy control teeth 1.500 ± 0.504. This showed that the plaque and debris accumulation on the teeth restored with SSC was comparatively lesser than that on the control teeth. This is in agreement with the study conducted by Beldüz Kara and Yilmaz who found that plaque did not accumulate for the first 9 months around the teeth that were restored with an SSC because of the smooth surfaces of the SSC. The smooth surface of an SSC is a frequently cited reason for decreased plaque adherence to surfaces that are adjacent to SSC.
Gingivitis is a relatively mild gum disease, which without appropriate treatment can lead to periodontitis, a more severe gum disease. Both affect many peoples, including children, which is when these diseases are usually manifested. In young individuals, gingival and periodontal diseases tend to be less dramatic than in adults. Checchio et al. concluded that individuals with poor oral hygiene showed pronounced tissue degeneration despite the quality of the SSC and that improperly contoured restorations predispose the gingiva to more severe inflammation.
In our study, GI of SSC at 3 months showed a mean value of 1 and control teeth also had the mean value of 1. This indicates that the gingival status of teeth around SSC was similar to the healthy control teeth at the interval of 3 months. At 6-month period, the gingiva around SSC showed a mean of 1.216 ± 0.415 whereas the contralateral teeth showed the mean value of 1 indicating that the gingival status of molar teeth restored with SSC deteriorates over time compared to control teeth in the children with good oral hygiene. This result is in agreement with a study conducted by Webber who noticed clinically there was a slight gingival change in patients 8–12 years old which may be due to a physiological process during the period of mixed dentition. He stated that the length of time using the crown did not seem to have any noticeable effect on the gingival tissues. Beldüz Kara and Yilmaz found that the GI scores increased progressively with time, it was never >1.
In our study, the radiographic examination of the alveolar bone adjacent to the teeth restored with SSC had a mean score of 1.841 ± 0.251 and mean value of control teeth was 1.866 ± 0.222 at 3 months. This showed more bone resorption in control teeth compared to the study teeth. At 6-month evaluation, the study teeth had mean value of 1.975 ± 0.282 and in control teeth 2.333 ± 0.438 [Table 2]. This indicates that interdental bone around control teeth underwent more resorption compared to the study teeth. When the bitewing radiographs of different intervals were compared, the alveolar bone had resorption at 3 months and at 6 months in the control teeth. Moreover, in teeth restored with SSC, the alveolar bone underwent resorption at 3 and 6 months compared to the initial bitewing radiograph. On comparing the values of the study teeth to control teeth, there was more bone resorption in control teeth than in study teeth. This is in agreement with the gingival status of the two groups. This is in accordance with the result found by Koth et al. that the gingival margin placement of a crown has only limited effect on the indices of the periodontal health of patients with good oral hygiene. Palomo and Peden noted that crowns with subgingival extensions produced more gingival inflammation than those placed supragingivally. Myers also reported a clinically significant association between crown defects and gingivitis.
|Table 2: Correlation of radiographic bone health for study and control teeth|
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In our study, 71.7% of the crowns had sealed margins and 28.3% crowns had open margins. There was no significant effect of level of crown margins on the gingiva at 3 months [Table 3]. There was significant difference at 6 months where the crowns with sealed and open margins showed the signs of gingivitis around them [Table 4] and [Graph 2]. There was no difference in the OHI at 3 months between two types of margins. At 6 months, the OHI of both the types of crown margins increased. This is in agreement with the study conducted by Beldüz Kara and Yilmaz in which the GI score increased as the increase in duration. Wiland and Marcum found that the improper marginal length and contouring of the crowns caused gingival inflammation, and on the other hand, Richter and Ueno found that margins of the crowns had no effect on the gingival tissues.
|Table 3: Gingival score distribution among various crown margins at 3 months|
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|Table 4: Gingival score distribution among various crown margin adaptations at 6 months|
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Crown marginal extensions were evaluated clinically in our study, 30% crowns extended till gingiva and 70% extended below the gingival margin. Both the types had the gingival score 1 at 3 and 6 months. On evaluating the oral hygiene at 3 months, both the crown had the score 0 and 1. At 6 months, 3 crowns with margins at gingiva and 6 crowns with the margins below gingiva had the score 2. This indicates that the oral hygiene of the teeth restored with SSC deteriorates with the time.
On evaluation of crown margins for the extension radiographically, 86.7% crowns were extended adequately whereas 13.35% crowns were extended inadequately. On evaluating the GI at 3 months, both the crown extensions had the score 1. On 6 month evaluation, the score was 2 for 20% of adequately extended crowns and 1.7% of inadequate crowns [Table 5]. The OHI had the similar score for both the crown extension types. At 6-month evaluation, 16.7% crowns with adequate extensions had the score 2 and 1.7% [Table 6] and [Graph 3] of the crowns had the score 2 indicating plaque and debris accumulation on some teeth restored with SSC. In another study, Sharaf and Farsi reported that interproximal bone resorption after placement of an SSC on primary molars was not adversely affected by an extension or adaptation of the crown's margin, a tight proximal contact between molars, the level of oral hygiene, or the duration of crown's presence. Discrepancies of the subgingival margins of the SSC, however, have been implicated by some investigators as one of the causes of gingival inflammation after restoring a primary tooth with an SSC. They also showed that crown extension and adaptation or even maintaining intact contact between teeth had no effect on interproximal bone level which again agrees with published work that did not confirm a direct correlation between SSCs and interproximal bone resorption.
|Table 5: Distribution of gingival index score on radiographic crown extensions|
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|Table 6: Gingival index score among different radiographic extension of crown|
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The skill of the clinician in placing the SSC influences in minimizing the defects in SSC. The SSC is a valuable and indispensable part of the pedodontist's armamentarium. Properly utilized and handled SSCs will more adequately measure up to the requirements of dental excellence during modern research and advances in dental materials and manufacturing techniques.
| Conclusion|| |
Within the limitation of this study following conclusions can be drawn:
- When compared to control teeth, the teeth restored with SSC showed lesser plaque and debris accumulation at 3 months and 6 months
- At 3 months, the gingival status around the teeth restored with SSC and control teeth was similar whereas the values around SSC increased marginally at 6 months
- Radiographic bone level of the control teeth showed higher level of bone resorption compared to the teeth restored with SSC
- There was statistically significant difference in the oral hygiene, gingival status, and periodontal health around study and control teeth.
It showed that gingival and interproximal bone health does not get altered by the presence of SSC. The marginal extension and adaptation of the crown did not affect the supporting structures of primary molar teeth. There was less plaque accumulation on teeth restored with SSC than remaining teeth which are not restored with SSC. Hence, further studies are required to investigate the effect of SSC on the oral health status of children with long-term follow-up.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]