Composite core-supported stainless steel crowns enhance fracture resistance of severely damaged primary posterior teeth

Abstract

Extraction of severely damaged primary teeth has been the common treatment for early childhood caries. The early loss of primary teeth results in poor oral and general health in children. To assess fracture resistance of severely damaged primary molars restored with intracoronal core with and without stainless steel crown (SSC). Eighty extracted primary molars were divided into 4 groups: Group 1 MOD cavity; Group 2 MOLi cavity; Group 3 MODLi and Group 4 MODBLi. Pulpectomy and core build-up with and without SSC placement were carried out and subjected to fracture resistance testing to examine the load to fracture and type of fracture. Fracture loads of 870–950 N were observed in the fabrication of intracoronal composite core in teeth with 1–2 remaining tooth walls whereas higher fracture load of teeth with extensive loss of all the surrounding wall following intracoronal composite core build-up was 1270 N. Following SSC placement, all groups had higher fracture load, with Group 4 being resisted to the highest force at 5500 N. Without SSC, Group 1 and Group 2 appeared to be restorable whereas Group 3 and Group 4 were non-restorable when fractured. Following SSC placement, all groups showed non-restorable fracture at the root furcation. Combined intracoronal core and SSC significantly strengthen the restored severely damaged primary molars with severe loss of coronal tooth structures. This proposed restoration method provided resistance to occlusal load that is much higher than the physiologic chewing force in children.