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posted: 3/18/2013 6:04 AM

A crowning achievement for kids' dental care

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  • Technician Antonina Mykhailenko applies a glaze to a pediatric dental crown. Although natural-looking crowns for adults have been made for decades, stainless-steel crowns were more common for children.

      Technician Antonina Mykhailenko applies a glaze to a pediatric dental crown. Although natural-looking crowns for adults have been made for decades, stainless-steel crowns were more common for children.
    SHNS photo

  • Monolithic zirconia pediatric dental crowns are ready to be stained.

      Monolithic zirconia pediatric dental crowns are ready to be stained.
    SHNS photo

 
By Mark Glover
Sacramento Bee

Two California dentists claim they have the most revolutionary development in children's dental care "since fluoride."

Jeffrey Fisher and John Hansen started EZ-Pedo Inc. in 2010, and today produce thousands of ceramic dental crowns for children.

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The crowns are made of zirconia, colored and polished to resemble healthy teeth. That's a departure from the long-standing industry norm -- metal crowns, typically made of stainless steel.

Last year, EZ-Pedo sold nearly 40,000 crowns to 650 pediatric dentists throughout the United States, and to various international locales. It's ramping up an office in Germany to handle manufacturing and distribution throughout Europe.

The partners guess that they have about 10 percent of the nation's pediatric crown market and hope eventually to claim 50 percent.

Fisher, 39, provides office-based general anesthesia for pediatric dentistry. Hansen, 45, is a specialist in cosmetic dentistry.

Their venture began with a nasty fall.

In 2004, Hansen's 3-year-old son, John Paul, fell in the bathtub and seriously injured four of his front teeth. Hansen sent his son to a pediatric dentist to have the boy's smile reconstructed and was stunned to learn that there were no aesthetically pleasing crowns like those typically custom-crafted for adults.

Hansen said the crowns placed on his son's teeth were bulky, didn't match in color and showed metal at the gum line when the boy smiled.

When John Paul needed more work done, Hansen called Fisher, with whom he had previously worked, to see if he would provide the anesthesia.

From there, Hansen and Fisher got to talking about better restorative options for children's teeth.

In 2006, they began an exhaustive process that included interviews with scores of pediatric dentists and numerous tests of potential ceramic materials. They went through 15 design revisions in three years.

Ultimately, they filed an application with the U.S. Food and Drug Administration for premarket clearance of their crowns. The FDA cleared them for use in 2009.

The zirconia crowns are first milled in a custom-made machine. About 35 to 50 crowns placed in a disc can be shaped simultaneously.

From there, the crowns are smoothed, polished, put through a staining solution, hardened in a 4,000-degree chamber, microblasted and glazed. Workers hand-paint the final glazes to match existing teeth.

There are 96 shapes and up to six sizes for each specific tooth, from baby to preteen. EZ-Pedo's crowns also are designed to provide proper spacing in the ever-changing mouths of growing kids.

Ceramic crowns are helping parents make better decisions, says Brian Banks, who's completing his residency at Primary Children's Medical Center in Salt Lake City.

"A lot of parents didn't like the silver option and would sometimes decide on extraction instead," Banks said. "Taking teeth out creates other problems," such as improper spacing or youngsters having a hard time eating.

Demand for crowns is not likely to ebb. Despite the proliferation of fluoride and dental sealants over the years, tooth decay among children has proved a stubborn foe.

As recently as 2007, a U.S. Centers for Disease Control and Prevention report warned that tooth decay in baby teeth was increasing among children ages 2 to 5 years.

Tooth decay "remains a problem for some racial and ethnic groups, many of whom have more treated and untreated tooth decay compared with other groups," said Bruce Dye, an epidemiologist and lead author of the 2007 CDC report. In a separate report released in May 2012, Dye said 20 percent of American children ages 5 to 11 had untreated cavities.

A just-released report by the Pew Center said most states are not doing enough to provide children with access to dental sealants to prevent tooth decay, driving up health care costs. Twenty states received "D" or "F" grades.

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