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 girl child reported to our clinic with the chief complaint of discolored and decayed teeth. Clinical and radiographic examination revealed roots of 51, 52, 61, 62, 71, 72, 73, 81, 82, 83 and carious 54, 55, 64, 65, 74, 75, 84, and 85. Along with management of carious teeth, complete preventive care was given to patient.\nAll retained roots and 84 were extracted. Pulpectomy was performed (as described for the previous case) in 74 and75 followed by stainless steel crown in 74 and composite restoration in 75. Prosthetic rehabilitation consisted of removable partial denture. Reconstruction of grossly decayed 73 and 83 was performed in the following steps:\nStep 1: Pulpectomy of 73 and 83 was performed as described for the previous case and coronal seal was established with GIC (GC Fuji II, Glass Ionomer Restorative, GC, USA) [].\nStep 2: Preparation of dentine post and core: These were prepared and sterilized in a similar way as described for the previous case. The only difference was in shape. For this case, the dentine part was trimmed so that it had approximately 2-3 mm length of post and similar length of core with wider buccolingual and mesiodistal dimensions when compared with post part [].\nStep 3: Removal of approximately 3 mm of coronal GIC to prepare post space.\nStep 4: Trial fit of prepared post and core unit. The mesiodistal and buccolingual dimensions of core were adjusted so that they allowed thickness of approximately ≥1-2 mm of composite material during final restoration.\nStep 5: Cementation of post and core unit was done in a similar way as described for the previous case [Figures and ].\nStep 6: Etching was done with 35% phosphoric acid (Scotchbond™ Etchant, 3M™/ESPE™ Dental Products, USA) for 15 s. Scotch bond multipurpose plus (3M™/ESPE™ Dental Products, USA) was applied following manufacturer's instruction.\nStep 7: Final buildup was done with Filtek™ Z350 XT supreme universal restorative (3M™/ESPE™ Dental Products, USA) composite material using incremental technique. Polishing and finishing was performed with composite finishing and polishing tips (CompoSite™ Finishing Kit, CompoSite™ Polishing Kit, Shofu, USA). Occlusion was checked in centric and eccentric positions.\nClinical examination [] at 1, 6 and 12 months showed these restorations to be functioning well with satisfied patient and parent.