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Case Report

Polycarbonate crowns for primary teeth revisited:

Restorative options, technique and case reports
Karthik Venkataraghavan, John Chan1, Sandhya Karthik2
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences and Research Centre, Ahmedabad, Gujrat, India, 1Kudos
Crowns Limited, Hong Kong, 2Vibha Dental Care Centre, Bangalore, Karnataka, India

ABSTRACT
Esthetics by definition is the science of beauty that
particular detail of an animate or inanimate object
that makes it appealing to the eye. In the modern,
civilized, and cosmetically conscious world,
well-contoured and well-aligned white teeth set
the standard for beauty. Such teeth are not only
considered attractive but are also indicative of
nutritional health, self esteem, hygienic pride, and
economic status. Numerous treatment approaches
have been proposed to address the esthetics and
retention of restorations in primary teeth. Even
though researchers have claimed that certain
restorations are better than the others, particularly
owing to the issues mentioned above, the search
for the ideal esthetic restoration for the primary
teeth continues. This paper revisits and attempts to
reintroduce the full coverage restoration, namely,
polycarbonate crown, for use in primary anterior teeth.

KEYWORDS: Caries, esthetic crowns, polycarbonate

crowns, restorations, temporary crowns

Introduction
Esthetics by definition is the science of beauty that
particular detail of an animate or inanimate object that
makes it appealing to the eye.
In the modern, civilized, and cosmetically conscious
world, well-contoured and well-aligned white
teeth set the standard for beauty. Such teeth are not
only considered attractive but are also indicative of
nutritional health, self esteem, hygienic pride, and
economic status.[1]
There is a rapid increase in the awareness among
parents of children for solutions to problems related to
nursing bottle caries, malformed and discolored teeth,
hypoplastic defects, tooth fractures, and bruxism.
The main problem facing the clinician while

Address for Correspondence:

Dr. Karthik Venkataraghavan, M.D.S,
Professor and Head, Department of Pedodontics and Preventive
Dentistry, College of Dental Sciences and Research Centre,
Opposite Pleasure Club, Bopal-Ghuma Road, Manipur,
Tal: Sanand, Ahmedabad 382115, Gujrat.
E-mail: veekart@yahoo.co.in

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Website:
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DOI:
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performing esthetic restorations in children is the

small size of teeth, proximity of the pulp to the
tooth surface, relatively thin enamel and surface
area for bonding a restoration, and the behavior of
the child. The major fallout of these problems is the
development of abnormal oral habits, psychological
problems, reduced masticatory efficiency, and loss of
vertical dimension of occlusion.
Owing to these problems, it becomes all the more
important to restore the destroyed crowns to preserve
the integrity of the primary dentition until its
exfoliation and eruption of permanent teeth.
Numerous treatment approaches have been proposed
to address the esthetics and retention of restorations in
primary teeth.[2] Over the years, there have been four
types of full coverage restorations available to restore
primary incisors:
Stainless steel crowns[3]
Open-faced stainless steel crowns[4]
Polycarbonate crowns[5]
Strip crowns[6]
The major stumbling block for these treatment options
is the cost of the restoration. Although all of them

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

have their advantages, the limitations cannot be

overlooked. These limitations described so far include
the following:
Metallic appearance[3]
Increased chair time using multiple materials[4]
Poor retention
Excessive wear
Technique sensitiveness
Importantly, the cost
Several studies have been carried out to determine
the strengths and weakness of the available treatment
options, but unfortunately so far there has been a
mixed response.
Even though researchers have claimed that certain
restorations are better than the others, particularly
owing to the issues mentioned above, the search for
the ideal esthetic restoration for the primary teeth
continues. One of the options available apart from the
routine tooth-colored restorations is the polycarbonate
crown. This paper discusses the various applications
of these crowns.

Primary tooth polycarbonate crowns

This paper revisits and in a way attempts to reintroduce

one of the four full coverage restoration, namely,
polycarbonate crown, for use in primary anterior teeth.
Although these crowns have been available to clinicians
for a few years now, owing to the initial published
reports pertaining to its retention capabilities, it never
got its due recognition. KudosTMTemporary Pediatric
Crowns, is a crown that is easy to use and handle along
with considerably reducing the chair side working
time thereby overcoming the difficulties reported so
far pertaining to placement and retention. They are
available as both individual as well as full arch crown
and bridge both for the maxillary and mandibular
anterior and posterior teeth, respectively.
This is a newer generation of Pediatric polycarbonate
crowns, which is more clinician friendly and
esthetically acceptable. The material is flexible, easily
adaptable, and reduces the chair side placement time
considerably.

Advantages

Esthetically acceptable
Less chair side time
Improved retention
Flexible
Better adaptability

Disadvantages

Breakages
Dislodgement
Discoloration
157

Placement technique

A through assessment of the case has to be carried out

with regards to availability of crown structure, over jet,
overbite, habits, infections, and so forth.
Once the assessment is completed, appropriate crown
selection is done with care taken to determine the
overall fit of the crown over the tooth.
The tooth to be restored is then prepared first
mesiodistally followed by incisal reduction, leaving a
featheredge margin. Care should be taken to prepare
the tooth minimally.
A trial fit is carried out to check for proper fit, marginal
adaptability, overall coverage, occlusal interference,
and mesiodistal width.
Necessary adjustments are made to the polycarbonate
crown, using either a crown cutting scissors or a
trimming stone. Care must be taken to seat the crowns
on to the prepared margins.
After the final fit is done, the crown is relined using
a self-cure acrylic resin. The advantage of this type of
relining technique is that the resin chemically bonds
to the polycarbonate crowns. By priming the inside of
the relined crown, it can be bonded to the tooth using
composite resin or glass ionomer cement.
After the complete set of the reline material, the
margins are trimmed and finished and the crown is
cemented using a luting cement or composite resin.
The firmness of the crown allows it to serve as a
provisional crown restoration up to several months/
years to protect the patients teeth from trauma.

Case Reports
Case 1

A male patient (aged 4 years) reported with a

complaint of discolored restoration in the upper front
teeth. Clinical examination revealed the presence of
discolored composite restoration in 51 and 61. The
parent gave a history of trauma and subsequent pulp
therapy in 51. Owing to the unesthetic nature of the
restoration, the parents wanted a crown restoration
to be done on the affected teeth. The patient was
carefully assessed according the parameters required
for restoration using the polycarbonate crown. Once
the parameters were found to be satisfactory, it was
decided to restore the discolored teeth. Complete
removal of the old restorative material and secondary
decay below the restoration was carried out followed
by restoration with polycarbonate crowns [Figures 1
and 2]. The patient has been under periodic clinical
evaluation every 6 months for the last 18 months and
the crowns have been found to be intact.

Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

Case 2

A female patient (aged 2 years 11 months) reported

with the chief complaint of discolored front teeth.
Clinical examination revealed the presence of carious
51 and 61. After careful assessment of the condition,
appropriate crown selection was done followed by
complete caries removal. The selected crown was then
cemented after performing the necessary procedures
required for its placement [Figures 3 and 4]. The
patient has been under periodic clinical evaluation
every 6 months for the last 24 months.

Case 3

A male patient (aged 3 years 10 months) reported with

a chief complaint of decayed front teeth. The main
complaint of the parent was the aversion of the child
toward dental treatment. The child was unwilling to have
his dental examination. As the child was uncooperative,
the treatment was carried out under general anesthesia
after obtaining all medical clearances and signed
informed consent from the parents. Complete caries
excavation was performed on 51, 51, 61, and 62 followed
by preparation of the teeth, and polycarbonate crown
and bridge was cemented in place [Figures 5 and 6]. The
postoperative healing was uneventful and the patient is
under periodic clinical evaluation since past 2 years.

Case 4

A male patient (aged 4 years 2 months) with a history

of restorations to the maxillary central and lateral
incisors reported with a complaint of fractured
restorations. Clinical examination revealed the
presence of dental caries in 54, 64, 74, and 84 apart from
restored maxillary anterior teeth. After careful caries
excavation of the posterior teeth, they were restored
with stainless steel crowns. The major concern of the
parents was the longevity of the anterior restorations.
As the patient was found to be cooperative after careful
clinical evaluation and preparation of the anterior
teeth, the teeth were restored with polycarbonate
crown and bridge [Figures 7 and 8]. The patient is
under a routine follow up protocol since the past
30 months.
All the aforementioned cases have been recalled for
periodic check ups to evaluate the crown restorations.
During the visits so far, the crowns were evaluated
for any kind of breakage or dislodgments. All the
restorations in the respective cases were found to be
retaining well with an average survival of 24 months.
Going by the presentation of the varied clinical cases
it can be concluded that polycarbonate crowns for

Figure 1: Case 1Before

Figure 2: Case 1After

Figure 3: Case 2Before

Figure 4: Case 2After

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Venkataraghavan, et al.: Polycarbonate crowns for primary teeth revisited

Figure 5: Case 3Before

Figure 6: Case 3After

Figure 7: Case 4Before

Figure 8: Case 4After

primary teeth after proper case selection is a good

treatment option available to the dentist, which will
help in restoring esthetics and improve the selfesteem of the patients and at the same time protecting
the tooth.

References

Improved modifiability and adaptability of Kudos

crowns will make them easy to place with less chair
side time and better patient acceptance.
Compared with conventional restorations, these
crowns provide an overall protection to the affected
tooth and at the same time help in restoring the
damaged tooth.
Patient and parent acceptance is greatly increased.
Finally, the cost of treatment is considerably reduced.
The main aim of this paper is to offer the clinician and in
particular pediatric dentists with an alternative treatment
option in their pursuit of restoring the beautiful smiles of
children they see in their practices everyday.

159

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How to cite this article: Venkataraghavan K, Chan J,

Karthik S. Polycarbonate crowns for primary teeth revisited:
Restorative options, technique and case reports. J Indian Soc
Pedod Prev Dent 2014;32:156-9.
Source of Support: Nil, Conflict of Interest: None declared.

Journal of Indian Society of Pedodontics and Preventive Dentistry | Apr-Jun 2014 | Vol 32| Issue 2 |