Practicing dentists: Do you usually place SSCs or resin/GI after pulpotomies?

[Mauricio45]

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I recently graduated dental school and was trained to do SSCs [stainless-steel crown] after all pulpotomies. Now that I have been in the “real world,” I am curious about the subject. On very decayed teeth I have no problem with a SSC, but what about the ones we all see, with that DO or MO that go straight to the pulp and once the decay is gone and access for the pulpotomy is made, there is a lot of healthy tooth structure left? I have to be honest, I feel a resin or glass ionomer under nice rubber dam isolation might be a valid option, especially if the patient is eight or nine years old and may exfoliate the tooth in the next couple of years. Also, I am not asking because I don’t like to place SSCs. I am not the quickest at it, but I don’t mind doing them. I would appreciate any helpful advice or criticism about this. Thanks in advance.

 

[privatedds]

I recently graduated dental school and was trained to do SSCs [stainless-steel crown] after all pulpotomies. Now that I have been in the “real world,” I am curious about the subject. On very decayed teeth I have no problem with a SSC, but what about the ones we all see, with that DO or MO that go straight to the pulp and once the decay is gone and access for the pulpotomy is made, there is a lot of healthy tooth structure left? I have to be honest, I feel a resin or glass ionomer under nice rubber dam isolation might be a valid option, especially if the patient is eight or nine years old and may exfoliate the tooth in the next couple of years. Also, I am not asking because I don’t like to place SSCs. I am not the quickest at it, but I don’t mind doing them. I would appreciate any helpful advice or criticism about this. Thanks in advance.

Come to think of it. You must place SSC unless parents absolutely hate silver in kid's mouth

Here are few reasons

1. Once you do pulpotomy, you erased hefty portion of occlusal portion and even if you fill it, there is a high chance that the tooth may fracture in the future.

2. Or even if the tooth doesn't fracture, there will always be a chance of restoration fracturing -> leakage -> abscess -> exo. Not worth it. (Personally, I have seen quite a lot of P/GI comeback with a failure - either abscess or missing filling.)

3. On the other hand, SSC gives full coverage restoraiton and can withstand occlusal force.

Lastly, MO or DO that goes into pulp is most likely to go subG at the box - really hard to do good restoration for such reason.




Therefore, SSC > GI. Of course, if the kids is 9/10 with tooth exfoliating in 1~2 year, GI is fine. Kids below that, SSC. Another option is full coverage zirconia like EZ pedo / Cheng crown but prepping this is a pain in the ass and I honestly don't want to do back to back full zirc resto on a chairside appt.

 

[drtoothyman]

Baby teeth get SSC, porcelain faced SSC for the front, or amalgams. Small anterior buccals get composites. If Pt is well behaved ill do posterior composites on baby teeth if I don't pulp. If the mom objects, I can usually talk them into metal after explaining that I will likely be extracting a composite over a pulpotomy in a couple of years due to recurrent decay and infection. I've pulled a ton of baby molars from other offices that only did composite on baby teeth.