A 5.5-year-old boy came to the clinic with his mother with a simple complaint: his front teeth were badly decayed. He had never experienced pain, fallen, or suffered any trauma. Yet an intraoral examination revealed a different story. All four of his primary incisors—teeth 52, 51, 61, and 62—had extensive dentinal caries involving the entire crown surface. According to the ICDAS system, the lesions were classified as Class 5 caries. If left untreated, the condition could have consequences extending far beyond appearance.
The case was documented by drg. Putri Kusuma Wardani Mahendra, M.Kes., Sp.KGA., a staff member of the Department of Pediatric Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, together with colleagues from the Pediatric Dentistry Specialist Education Program at UGM. The case report was published in the August 2023 issue of Jurnal Surya Medika and highlighted a restorative technique that remains relatively unfamiliar in Indonesia: the strip crown.
More Than Just Appearance
Many parents, and even some dentists, still consider decay in primary teeth to be relatively unimportant. After all, baby teeth will eventually fall out. Clinically, however, this assumption is incorrect.
Caries or loss of anterior primary teeth can lead to a range of functional consequences, including pain, difficulty speaking, impaired chewing, loss of vertical dimension, and malocclusion. Beyond these consequences lies another dimension that is often overlooked. In children, dental aesthetics can have a significant impact on psychosocial development and interactions with peers. Children whose teeth appear damaged may withdraw socially, lose confidence, or even become targets of bullying.
The WHO estimates that more than 530 million children worldwide suffer from caries in their primary teeth. In Indonesia, these cases often end with one of two choices: leaving the condition untreated or extracting the teeth. A third option—restoring the teeth using an appropriate technique—remains relatively unfamiliar.
Celluloid Crowns That Transform a Smile
A strip crown is a transparent celluloid crown form filled with composite resin, glass ionomer cement, or resin-modified glass ionomer cement (RMGIC). The technique is considered an excellent aesthetic option for restoring primary incisors, producing a smooth, glossy surface with a color that can be matched to the natural teeth.
In this case, treatment was completed over two visits. The first visit, on October 25, 2021, involved teeth 51 and 61, while the second visit, on December 6, 2021, involved teeth 52 and 62. The procedure included selecting the strip crown according to the mesiodistal width of the tooth, removing carious tissue, applying glass ionomer cement as a lining over exposed dentin, followed by etching and bonding. The crown form was then filled with A2-shade flowable composite resin. After light curing for one minute on both the labial and palatal surfaces, the celluloid crown was removed. The final steps involved finishing and polishing.
The result was striking: all four anterior teeth regained a natural shape and color.
“Strip crown restoration can be considered a treatment option for primary anterior teeth with caries involving the entire surface, providing satisfactory aesthetic results with a relatively short treatment time.” — drg. Putri Kusuma Wardani Mahendra, M.Kes., Sp.KGA., and research team
A Technique That Requires Precision
The advantages of strip crowns are extensive. In addition to their aesthetic benefits, they cause minimal trauma to periodontal tissues, do not injure the pulp of vital teeth, and are available in a variety of sizes. The procedure is also relatively quick, which is particularly important for pediatric patients whose ability to cooperate may be limited.
However, the technique is not without challenges. Strip crowns are technique-sensitive. Their retention depends heavily on how much tooth structure remains after caries removal. Bleeding or saliva contamination during the procedure can compromise the final result. The technique is also not recommended for patients with bruxism or severe overbite. One study cited in the case report found that 80% of strip crowns remained intact after three years, while the remaining 20% retained only half of the crown.
This is where specialist expertise becomes crucial. Treatment planning for pediatric patients must take into account dental development, caries risk assessment, oral hygiene, parental compliance, and the child's ability to cooperate during the procedure. Communication, information, and education for parents are not merely formalities; they are integral components of successful restorative treatment.
Familiar, but Not Yet Widely Used
This case report arose from the recognition that strip crowns remain unfamiliar in many dental practices in Indonesia. Although the technique is clinically well established and supported by international literature, the gap between the availability of the technique and its implementation in everyday practice makes publications like this particularly relevant—not only as clinical documentation but also as a bridge between research and routine dental care.
For the child himself, he may not have fully understood the changes in medical terms. But the smile he took home after two visits—a smile with intact, naturally colored front teeth—was enough to demonstrate that there are better options than simply extracting the teeth or leaving them untreated.
Source DOI: https://doi.org/10.33084/jsm.v9i2.5710
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
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