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From Freehand to Foolproof: Using Strip Crowns for Anterior Trauma Cases

All dentists learn at one point or another, pediatric dentistry presents a unique set of challenges. Among them are behavior management, limited attention spans, and the need to work efficiently while still achieving predictable outcomes. Materials and techniques that simplify treatment are invaluable, with minimally invasive dentistry being really hot right now. 

Early on in my career, I began gravitating toward products and techniques that helped streamline my workflow without sacrificing esthetics or durability. That process ultimately led me to OMNICHROMA. After receiving a free sample at the Greater New York Dental Meeting, I started incorporating OMNICHROMA into regular use. It quickly became a staple material in my practice, and one that I continue to rely on for restorative cases.

OMNICHROMA'S name is true to form with its line of composite products. As an all-purpose composite, its excellent physical properties are on par with the other brand leaders, with the automatic matching shades to boot. I have previously written about what makes OMNICHROMA a no-brainer in my practice for that reason alone, but today I would like to share a unique approach in using it to restore anterior trauma cases.

Coming out of school and residency, I was taught and practiced restoring these cases “free hand.” While I had no problem achieving the result I wanted, I’m sure all dentists can relate to how time-consuming Class IV’s can be. While other products and techniques exist with varying cost and complexity, I find that the best way to predictably, effectively and efficiently treat is with strip crowns.

As a pediatric dentist, I routinely place strip crowns on primary incisors. Through repetition, I naturally improved my esthetic skills and results over time. For any general dentist reading who may not be as familiar, it basically involves filling uncured restorative material into a tooth-shaped plastic mold, placing and curing it onto the tooth, and then removing the mold to leave behind a cured restoration. While for carious primary teeth we typically prefer glass ionomer for strip crowns (in vogue among pediatric dentists), for adult teeth we certainly prefer composite for its superior physical properties.

 

To break it down step-by-step, the technique involves:

  1. Bevel/etch/bond (business as usual)

    a.  (Tip: Etch for a full 30 seconds. Surface area is your friend for retention)
  2. “Free hand” a small layer of OMNICHROMA BLOCKER to restore general shape
  3. Choose the correct size strip crown (my preferred brand for pediatrics and adults is Nowak) and trim to incisogingival length with scissors
  4. Fill the strip crown with OMNICHROMA Flow BULK

    a.  (Tip: pack starting from the incisal edge to prevent voids)
  1. Cure both sides
  2. Use a scaler to flick off the cured excess
  3. Remove (or strip–hence the name) the plastic mold off with an explorer
  4. Cure one more time for good luck
  5. If necessary, adjust occlusion and use a fine finishing bur or finishing strips to polish 
Pre- and post-operative dental X-rays of anterior teeth with strip crown composite restorations. Anterior teeth radiographs showing composite strip crowns before and after treatment.

 

That’s it, you’re done. Better and faster. The average treatment time is less than 10 minutes. You’ll usually find the margins seamless and the finishing flawless. I also find that because the restoration is basically full coverage, the retention is a lot stronger than free hand.

I would recommend this to any pediatric dentist already doing strip crowns on primary teeth as another no-brainer to add to your toolkit. The technique is so simple I would certainly recommend that general dentists try it out and expect a one-case learning curve at most, especially considering your patients don’t play defense.

Marc Nardea, DMD
Marc Nardea, DMD
Dr. Marc Nardea, owner of Midtown Pediatric Dentistry, is a board-certified pediatric dentist and a diplomate of the American Board of Pediatric Dentistry. He earned his DMD from Rutgers and completed his pediatric specialty training at St. Christopher’s Hospital. He also served as the head of pediatric dentistry for the largest multispecialty dental service organization in the Northeast. He and his wife, Sally, currently live in Manhattan with their daughter, Lainey. Website: midtownpd.com

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