A 7-year-old boy reported to our clinic with the chief complaint of decayed teeth. Clinical and radiographic examination revealed multiple carious lesions in all teeth with retained roots of 61, 62. Complete preventive care was provided, retained roots were extracted and all carious teeth were restored. Primary mandibular first molar (84) was grossly carious [] and a decision to place biologic shell crown was made.\nThe operative procedure is described below:\nStep 1: Biologic shell crown preparation: Primary mandibular right first molar (possibly extracted for serial extraction) was selected based on mesiodistal dimensions of the tooth to be restored. The selected tooth was sectioned approximately 1 mm occlusal to cemento-enamel junction. Any remaining pulp tissue was removed using sharp spoon excavator. All undercuts were removed and dentinal surfaces were prepared to diverge cervically. The cervical margin was prepared flat with rounded internal line angles so that it can be seated on prepared margin of primary mandibular first molar. Sterilization was performed as described previously.\nStep 2: Complete caries excavation was performed under local anesthesia with area isolated using rubber dam. After caries removal, a layer of GIC (GC Fuji II, Glass Ionomer Restorative, GC, USA) was placed. Circumferential shoulder margin with rounded internal line angles was placed using round end tapered diamond parallel to long axis of tooth []. Withdrawal form was established by rounding of all line and point angles and removing all undercuts.\nStep 3: Rubber dam was removed and occlusal clearance was checked using modeling wax sheet.\nStep 4: Trial fit of biologic shell crown was done and adjustments were done if needed [].\nStep 5: Etching of dentinal surfaces of prepared biologic shell crown and prepared tooth surfaces was done with 35% phosphoric acid (3M™/ESPE™ Dental Products, USA) for 15 s. Final cementation was performed using dual cure resin cement (RelyX™ U100 Self-Adhesive Resin Cement, 3M™/ESPE™ Dental Products, USA) following manufacturer's instructions.\nStep 6: Final check for occlusion in centric as well as eccentric positions to check for any functional interferences. Thin carbon paper was used and pre-maturities, if any were removed.\nStep 7: Finishing and polishing of margins was done with composite finishing and polishing tips (CompoSite™ Finishing Kit, CompoSite™ Polishing Kit, Shofu, USA).\nClinical examination [] at 1, 6, and 9 months showed the cemented biologic crown to be functioning well in the oral cavity.
A 4-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry with a chief complaint of decayed upper front teeth. Patient's medical history was noncontributory. Patient's mother gave a history of breast feeding for 1 year after which the child was bottle fed for 3 years. Intraoral examination revealed a complete set of deciduous dentition. It was observed that 55, 52, 51, 61, 62, 65, 71, 72, 73, 74, 75, 81, 82, 83, 84, and 85 were affected by dental caries (). Intraoral periapical radiographs revealed pulp involvement with 52, 51, 61, and 62 (). Diet analysis, counseling, and oral prophylaxis were done. 74 and 75 were grossly carious and were indicated for pulpectomy followed by a stainless steel crown (). 52, 51, 61, and 62 were indicated for pulpectomy, followed by glass fibre-reinforced composite resin posts and composite buildups. 55 and 65 presented with pit and fissure caries and were indicated for composite resin restorations.\nThe treatment plan was divided into 2 steps for 51, 52, 61, and 62.\nAn infraorbital block was administered for 61 and 62, and labial and palatal infiltration was carried out for 51 and 52. Gross carious lesions were removed with a no. 330 round carbide steel bur. Unsupported enamel was not removed so as to preserve as possible. The pulp chamber was opened and working length determination IOPA was taken with a no. 10 K-file.The pulp tissue was extirpated using no. 10–no. 35 K-files. After irrigation with copious amounts of 2.5% NaOCl and normal saline, the root canal was dried using paper points. A thick mix of Endofloss paste was then condensed with lentulo spiral into the canal. The obturated material was allowed to set for 10 minutes ().\nThe post space was prepared 1 week after the endodontic treatment was completed. The post space was created by removing approximately 4 mm of Endofloss material using a thin straight fissure bur. All visible Endofloss cement on the walls of the post space was removed.\nThe prepared post space was then cleaned with saline, air dried, and acid etched with 37% phosphoric acid for 15 seconds. This space was rinsed and air dried with oil-free compressed air. A light-cured bonding agent was brushed on the etched surface and uniformly dispersed by a compressed air blast. It was then light cured with for 20 seconds. The GFRC post was then cured for 20 seconds in order to gain rigidity, before insertion into the post space. Light cured flowable composite resin was then inserted into the canal chamber after which the GFRC post was inserted (). The fiber post and composite were then cured with together for 60 seconds. The coronal portion of the glass fibre-reinforced composite post was splayed to increase the surface area for the retention of the core.\nThe coronal enamel was then etched for 20 seconds, rinsed with water and air dried followed by application of bonding agent—which was then light cured. The coronal post was then covered with the flowable composite for core build up, followed by light curing it for 60 seconds, and finally teeth were restored with hybrid composite. The final finishing and polishing was done with finishing burs. Occlusal interferences in normal and paranormal mandibular movements were removed ().