Introduction

Pediatric dentists have a responsibility to prioritize the aesthetic and functional rehabilitation of primary teeth that have been decayed or traumatized.¹ Tooth-colored restorations for deciduous, deformed, decayed, or traumatized teeth in children are difficult to manage due to small tooth size, larger pulpal chamber, thin enamel, decreased surface area, and behavior management issues.² Today, both parents and children are increasingly concerned about the aesthetics of their teeth.To provide quality clinical care, it is important to comprehend the aesthetic perception of both the child and their parents.^3,4

The management of severely damaged primary teeth and significant carious lesions has shifted towards the use of full-coverage restorations rather than extractions. In cases of primary teeth with developmental abnormalities, multi-surface caries, high-caries patients, broken teeth, teeth with a history of failed direct restorations, following pulpal treatment, as space maintainer abutments, and teeth with severe wear, extra-coronal full-coverage crowns are highly recommended.^5,6

There is increasing demand for attractive smiles among both children and adults. A child's physical and mental health, as well as their level of social acceptability and quality of life, can all be impacted by their appearance. In pediatric dentistry, a deliberate attempt has been made to introduce several full coverage restoration techniques. Every technique and material used in dentistry has its benefits and drawbacks. When it comes to treating tooth decay in pediatric patient, there are several options available. These include stainless steel crowns (SSC) and their modification, as well as other aesthetic alternatives such as Bioflx and zirconia crowns, which are gaining popularity.⁷

A new synthetic crown, called Bioflx, has been developed in pediatric dentistry to improve aesthetics and handling compared to other crowns. This crown provides a flexible fit that adapts to the anatomical curvature of the primary clinical crown. BioFlx is a new product that aims to improve the flexibility, color stability, and durability of glass fiber-reinforced composite crowns while offering a less invasive and aesthetic appearance, compared to pediatric zirconia crowns.⁶ This case report describes the first use of Bioflx crown in managing a multisurface caries lesion in an 8-year-old girl.

Case report

A girl of eight year old reported with a high risk dental caries and missing teeth in the lower left and right back tooth region (Fig.1, 2).  Pit and fissure sealants were applied in the teeth with deep pits and fissures. Glass ionomer restorations were done for teeth requiring restorations followed by lingual arch space maintainer. In case of mandibular left primary first molar caries did not involve the pulp but was very close to the pulp and distal marginal ridge breakdown was seen. After removing the caries, tooth needed a full-coverage restoration. Concerns were raised over its aesthetics by both the child and parent. We chose to use a pediatric Bioflx crown (Kids-e-Dental, Mumbai, India) to restore the tooth.

A similar sized prefabricated Bioflx crown was selected as per mesio-distal width and manufacturer’s instruction manual. Local anesthesia was administered, and tooth preparation was carried out using a tapered diamond bur, which reduced the occlusal surface by 1-1.5 mm, similar to a stainless steel crown preparation. The mesial contact area was also prepared by 0.5mm. The crown was then placed securely and contoured using a Howe's plier. Before cementing with a glass ionomer type I cement, the crown was trimmed with bridge scissors. Any excess cement was removed using floss and an explorer (Fig.3). Presence of dimples in the occlusal areas of heavy occlusion. This “dimple” appears due to the self-adaptable technology of the material. The tooth will be followed up until natural exfoliation (Fig.4)”.

Figure 1: Preoperative photographs of the patient Click here to view Figure

Figure 2: Intra Oral Periapical Radiograph wrt 74 Click here to view Figure

Figure 3: Intraoperative photographs of the patient Click here to view Figure

Figure 4: Outcome and follow up Click here to view Figure

Discussion

Stainless steel crowns (SSC) are the most effective treatment option for extensive tooth decay in pediatric dentistry; they are often rejected by parents due to aesthetic reasons. Fortunately, there are more aesthetic alternatives available nowadays, such as pediatric zirconia crowns. However, these crowns have some potential drawbacks, including the need for additional tooth reduction, the inability to crimp or contour the crown, and the higher cost.⁸

Bioflx crowns are new esthetic pediatric crowns which has features of both zirconia and stainless steel crown. They are metal and Bis-GMA (Bisphenol A-Glycidyl Methacrylate) free, monochromatic tooth-coloured crowns made of a biocompatible hybrid resin polymer used in the medical field requiring high strength, flexibility and durability which can mask the discoloration of arrested caries. Bioflx crowns have some unique design features in anterior and posterior crowns. It has radiopacity of ~1mm permits evaluation of the crown margins and pulp capping materials. Laser marking on the inner occlusal surface of these crowns are for easy identification and optimal esthetics. These crowns can be seated using a bite stick and trimmed if necessary with crown and bridge scissors , they also have sandblasted intaglio surface for enhanced retention with self-setting RMGI (Resin-modified glass ionomer) and GI (Glass ionomer)  cements, where a light-cures cement is not recommended. Its flex fit characteristics makes the crown distinctively strong yet flexible and versatile nature for easy placement and a snug/active fit. Tooth preparation and handling properties very similar to an SSC, saving valuable chair time. Bioflx is not recommended for the Hall technique, bruxism or manipulation by crimping. Wear resistance of Bioflx is similar to or better than traditional SSC. Rather than wearing, Bioflx crowns will self-adapt forming a dimple in areas of high occlusion and also stain resistance with no visible discoloration after > 1 year intraorally or when placed opposing an SSC. ⁹

BioFlx aims to address concerns about the ductility, color stability, and durability of glass fiber-reinforced composite crowns while maintaining the clinical benefits of a flexible fit, esthetic appearance, and more conservative tooth preparation, compared to pediatric zirconia crowns.⁶

In today's dentistry, aesthetics play a crucial role in treating decayed teeth, especially in children. Introducing the new Bioflx Crowns - the first of its kind in the world! These pre-formed pediatric crowns offer the perfect combination of flexibility, durability, and aesthetics, giving them properties similar to both zirconia and stainless steel crowns. They are the ideal solution for full coverage restoration, and are the perfect choice for the next generation of pediatric esthetic crowns. It is now one of the options for treating multisurface caries lesions in pediatric dental practice.

Conclusion/Recommendation

Currently, there is no published case report on the use of Bioflx crowns for primary molars. However, this case reports that primary molar with extensive caries can be effectively treated with Bioflx crowns, which are a suitable alternative to full crown restoration.

Acknowledgement

The authors express their gratitude to the Almighty.

Conflict of Interest

There is no conflict of interest.

Funding Source 

There are no funding sources.

References

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