When is a stainless steel band preferred over a Glass Ionomer Cement (GIC) dome technique for interim restoration between endodontic treatment?

Stainless Steel Bands vs. GIC Dome Technique for Interim Endodontic Restoration

Stainless steel bands should be preferred over GIC dome techniques when treating extensively broken-down posterior teeth or in patients with parafunctional habits (bruxism, clenching), as they provide superior fracture resistance and reduce cuspal flexure by 50%. 1, 2

Clinical Decision Algorithm

Choose Stainless Steel Bands When:

• Extensive tooth structure loss is present, where significant cuspal breakdown compromises structural integrity 1
• Parafunctional habits are documented (bruxism, clenching), which generate forces exceeding normal masticatory loads 1
• Maximum fracture resistance is required, as bands increase fracture resistance to 1282 N compared to 729 N without bands 2
• Cuspal protection is critical, since bands reduce cuspal flexure to half that of unprotected teeth (p < 0.001) 2
• High occlusal forces are anticipated during the interim period between endodontic appointments 2

Choose GIC Dome Overlays When:

• Moderate tooth breakdown exists with relatively intact cuspal structure 1
• Aesthetic concerns are paramount, as stainless steel bands are visible and may be unacceptable to patients 1
• Gingival health is compromised, since bands can cause gingival irritation that GIC domes avoid 1
• Proximal tooth structure preservation is needed, as band placement may require additional proximal tooth reduction 1
• Moisture control is suboptimal, since traditional GIC tolerates moisture during setting 3

Evidence-Based Performance Comparison

Fracture Resistance Data:

• GIC dome overlays demonstrate significantly lower fracture forces than stainless steel bands (p = 0.03), though they outperform conventional MOD GIC restorations (p < 0.001) 1
• Stainless steel bands provide the highest mean fracture force among all interim restoration techniques tested 1
• The risk of failure is significantly higher with conventional GIC MOD restorations compared to both stainless steel bands (p < 0.001) and GIC dome overlays (p < 0.001) 1

Fracture Pattern Considerations:

• Stainless steel bands produce significantly fewer unfavorable fractures compared to GIC (p = 0.001), GIC dome overlays (p = 0.007), and GIC-IRM combinations (p < 0.001) 1
• Unfavorable fractures (those extending below the CEJ or requiring extraction) are a critical consideration, as they compromise the restorability of the tooth 1

Clinical Technique Nuances

For GIC Dome Overlays:

• Reduce cuspal height and occlusal inclines when fabricating the dome to minimize fracture risk 1
• Use high-viscosity GIC for improved mechanical properties, though moisture tolerance remains an advantage 3, 4
• Avoid resin-modified GIC (RMGIC) if moisture control is compromised, as RMGIC requires completely dry surfaces similar to resin-based materials 3

For Stainless Steel Bands:

• Recognize that bands require proper adaptation and cementation to maximize their protective effect 2
• All bands must be properly sterilized before use as they are classified as critical instruments 5
• Consider that bands may cause aesthetic concerns and gingival irritation, limiting their use in certain clinical scenarios 1

Common Pitfalls to Avoid

• Do not use conventional MOD GIC restorations as interim restorations in broken-down posterior teeth, as they demonstrate the highest failure risk 1
• Avoid overestimating GIC dome overlay strength in patients with heavy occlusal forces or parafunctional habits 1, 2
• Do not select stainless steel bands solely based on fracture resistance without considering aesthetics, gingival health, and patient acceptance 1
• Never assume all GIC materials perform equally—traditional GIC tolerates moisture while RMGIC does not 3