DentaltownUK May 2017 - 29

Fig. 1. Separators in place

Fig. 2. Separator with orthodontic separator pliers

Fig. 3. Separator stretched with floss

Fig. 4. PMCs placed on opposite side
of same arch at same visit

management by a consultant or specialist. The
precooperative child who could challenge any
skilled clinician at maintaining a safe patent
airway may not be a candidate for this technique.
At the treatment planning stage and when
discussing the various options available to
manage a carious primary molar, the dentist
should be prepared to 'sell' the technique.
Don't be afraid to show the child the PMC;
most children don't mind the concept of a silver
crown as they can see it either as their very own
princess crown or Iron Man helmet and once
you have the child on board, convincing the
parent becomes easier. Like any dental procedure
for a child, the dentist should explain it from
beginning to end to prepare them for what's
going to happen. For children who require more
information, you can show them the equipment
and demonstrate the process on a tooth model.
The user manual5 advises that Hall crowns
can be successfully placed to primary molars in
contact with adjacent teeth as the periodontal
ligament can absorb the displacement necessary
to fit the crown. However, this depends upon
the cooperation of the child to bite it into
place, and often a young or anxious patient
is not keen to get that involved. In such cases
where there is no natural spacing, orthodontic
separators can be used to provide space between
the primary molars (Fig. 1). This allows easier
placement of a PMC with greater precision for
the dentist and a more comfortable experience
for the child. The placement of separators takes
no more than a few minutes and can either be

placed using an orthodontic separator plier
or two lengths of floss threaded through the
separator (Figs. 2 and 3). This is then pulled
taut and flossed through the contact point,
leaving the superior half of the band above the
contact point with the inferior half below (Fig.
1). The user manual5 advises they are left in situ
for 3-5 days for the ideal amount of spacing
to occur, but sufficient space has been noted
2-3 hours after placement.
Always check to ensure separators are in situ
at the following visit or if the patient or parent
is aware they've fallen out; occasionally they can
work their way under a contact point. They can
then be removed with either a straight probe
or tweezers. With the space created, visual
assessment of the shape and size of the tooth
is easier. Before sizing a crown, the patient
should be placed in a more upright position,
with airway protection throughout to prevent
inadvertent swallowing or inhalation. If marginal
breakdown has occurred or teeth have migrated,
you may have to adjust the tooth or the crown
itself with orthodontic band forming pliers. In
most cases, minimal adjustment is required due
to the precontoured, pretrimmed and crimped
PMCs available. Select the smallest crown
that provides cuspal coverage and approaches
the contact points with a slight spring-back.5
This is of particular importance for the second
primary molars, especially in the maxilla before
the eruption of the first permanent molar. It's
important to monitor their eruption to ensure
there's no impaction against the crown margin.

Refrain from fully seating the crown before
cementation because it can be difficult to
remove and require the use of an excavator or
a high-speed turbine. Once you've chosen the
best fit, dry and fill with an appropriate luting
cement such as glass ionomer and fully seat the
crown over the tooth by applying finger pressure
or by getting the child to bite the crown into
place, with a cotton wool roll placed over the
crown. Excess cement should then be removed
with either cotton wool or gauze, and the child
should then again bite upon the crown until the
cement is fully set to avoid spring back, which
could potentially create a breach in the seal.5
Remove any further excess and floss between
the contacts. For some patients taste can be
an issue and therefore toothpaste can be used
after placement as a distraction.
Lower second primary molars are the easiest
to begin with due to their singular contact point
(i.e., before the eruption of the first permanent
molar), direct vision and the ability for good
isolation and airway management.
Two crowns can be fitted at the same appointment, but these must be on either side of the
same arch (Fig. 4) or diagonally opposite in
different arches. It is recommended not to fit
crowns on opposing teeth at the same time
because the temporary occlusal interference is
exacerbated and it is usually difficult to fit two
Hall crowns in the same quadrant.5
Finally, check the degree of occlusal discrepancy; most children will accommodate some
change without symptoms and the occlusal
dentaltownuk.com \\ MAY 2017

29


http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK May 2017

On Dentaltown.com
Mike Gow Editorial
Meet the Team
Howard Speaks
Dental Aid Network
Titanium vs. Zirconia Implants
NASDAL Goodwill
Golden Nuggets
Orthodontist Case Study
Poll—Pediatric Dentistry
Technology: The True Foundation of Your Practice
Continuing Education
Timeout: Chris Barrow
Progressive Bites
Walt Disney's Hollywood Smiles
Dental Imaging: Elaine Halley
MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
The Art of Diagnosis in Endodontics
MESSAGE BOARD: 2nd Distal Root on 36
Social Media Fails
Operation Smile
THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
Lifestyle Section
History of Dentistry
Student Section
Wish List
DentaltownUK May 2017 - 1
DentaltownUK May 2017 - 2
DentaltownUK May 2017 - 3
DentaltownUK May 2017 - 4
DentaltownUK May 2017 - On Dentaltown.com
DentaltownUK May 2017 - Mike Gow Editorial
DentaltownUK May 2017 - 7
DentaltownUK May 2017 - 8
DentaltownUK May 2017 - 9
DentaltownUK May 2017 - Meet the Team
DentaltownUK May 2017 - 11
DentaltownUK May 2017 - Howard Speaks
DentaltownUK May 2017 - 13
DentaltownUK May 2017 - Dental Aid Network
DentaltownUK May 2017 - 15
DentaltownUK May 2017 - 16
DentaltownUK May 2017 - 17
DentaltownUK May 2017 - 18
DentaltownUK May 2017 - 19
DentaltownUK May 2017 - 20
DentaltownUK May 2017 - 21
DentaltownUK May 2017 - Titanium vs. Zirconia Implants
DentaltownUK May 2017 - 23
DentaltownUK May 2017 - 24
DentaltownUK May 2017 - NASDAL Goodwill
DentaltownUK May 2017 - 26
DentaltownUK May 2017 - Golden Nuggets
DentaltownUK May 2017 - 28
DentaltownUK May 2017 - 29
DentaltownUK May 2017 - 30
DentaltownUK May 2017 - Orthodontist Case Study
DentaltownUK May 2017 - 32
DentaltownUK May 2017 - 33
DentaltownUK May 2017 - Poll—Pediatric Dentistry
DentaltownUK May 2017 - 35
DentaltownUK May 2017 - Technology: The True Foundation of Your Practice
DentaltownUK May 2017 - 37
DentaltownUK May 2017 - 38
DentaltownUK May 2017 - 39
DentaltownUK May 2017 - 40
DentaltownUK May 2017 - 41
DentaltownUK May 2017 - Continuing Education
DentaltownUK May 2017 - 43
DentaltownUK May 2017 - 44
DentaltownUK May 2017 - 45
DentaltownUK May 2017 - Timeout: Chris Barrow
DentaltownUK May 2017 - 47
DentaltownUK May 2017 - Progressive Bites
DentaltownUK May 2017 - 49
DentaltownUK May 2017 - 50
DentaltownUK May 2017 - 51
DentaltownUK May 2017 - 52
DentaltownUK May 2017 - 53
DentaltownUK May 2017 - Walt Disney's Hollywood Smiles
DentaltownUK May 2017 - 55
DentaltownUK May 2017 - 56
DentaltownUK May 2017 - 57
DentaltownUK May 2017 - 58
DentaltownUK May 2017 - 59
DentaltownUK May 2017 - 60
DentaltownUK May 2017 - 61
DentaltownUK May 2017 - Dental Imaging: Elaine Halley
DentaltownUK May 2017 - 63
DentaltownUK May 2017 - 64
DentaltownUK May 2017 - 65
DentaltownUK May 2017 - 66
DentaltownUK May 2017 - 67
DentaltownUK May 2017 - MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
DentaltownUK May 2017 - 69
DentaltownUK May 2017 - The Art of Diagnosis in Endodontics
DentaltownUK May 2017 - 71
DentaltownUK May 2017 - 72
DentaltownUK May 2017 - 73
DentaltownUK May 2017 - MESSAGE BOARD: 2nd Distal Root on 36
DentaltownUK May 2017 - 75
DentaltownUK May 2017 - Social Media Fails
DentaltownUK May 2017 - 77
DentaltownUK May 2017 - Operation Smile
DentaltownUK May 2017 - 79
DentaltownUK May 2017 - 80
DentaltownUK May 2017 - 81
DentaltownUK May 2017 - THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
DentaltownUK May 2017 - 83
DentaltownUK May 2017 - Lifestyle Section
DentaltownUK May 2017 - 85
DentaltownUK May 2017 - 86
DentaltownUK May 2017 - 87
DentaltownUK May 2017 - 88
DentaltownUK May 2017 - 89
DentaltownUK May 2017 - 90
DentaltownUK May 2017 - 91
DentaltownUK May 2017 - 92
DentaltownUK May 2017 - 93
DentaltownUK May 2017 - 94
DentaltownUK May 2017 - History of Dentistry
DentaltownUK May 2017 - Student Section
DentaltownUK May 2017 - 97
DentaltownUK May 2017 - 98
DentaltownUK May 2017 - 99
DentaltownUK May 2017 - 100
DentaltownUK May 2017 - 101
DentaltownUK May 2017 - 102
DentaltownUK May 2017 - 103
DentaltownUK May 2017 - Wish List
DentaltownUK May 2017 - 105
DentaltownUK May 2017 - 106
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